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,� <br /> MINNEGASCO, INC. MAINTENANCE ORDER NO. <br /> O MAIN O SERVICE PAV.CUT NO. LEAK RPT.NO. <br /> DATE MUNIC. RESP.ACCT.NO. <br /> FPC-or-E NO. <br /> LOCATION: <br /> NATURE OF WORK <br /> FOREIGN STRUCTURES PRESS.CL. NEW SURFACE DISTURBED <br /> Tele O 1 O A TAP - <br /> 0 Road Mix Bituminous 0 Dirt <br /> Elec � 2 � C SIZE O Hot Mix Bituminous 0 Gravel <br /> O 5 � E � Portland Cement Concrete O Oiled Earth <br /> LighVTraf.Cable O 6 p F <br /> � 8 ❑ K � Roadway 0 Blvd. � Walk 0 Alley <br /> Other <br /> Size Disturbed <br /> PIPE LENGTH O Same Ft. Longer Ft.Shorter Ft.Abandoned <br /> SERVICE TAP MEASUREMENT <br /> DATESTARTED COMPLETED FOREMAN <br /> TRUCK NO. TOWN NO. FOREMANS P.R.NO. <br /> To the (City Engineer <br /> (City Council <br /> (Village Council <br /> (Town Board <br /> The u�dersigned hereby requests permission to perform the work <br /> indicated above. <br /> :g;��.,m,,,,�._; MINNEGASCO, INC. <br /> ', � <br /> (Sr. Design Engine� <br /> ., <br /> To Minnegasco, Inc. <br /> Permission is hereby granted Minnegasco, Inc. to perform the <br /> work indicated above. <br /> of <br /> Date By <br /> (Authorized Signature) <br /> FORM 45A R3/78 <br />