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MINNESOTA GAS CO.MAINTENANCE ORDER NO. <br /> ❑ MAIN ❑ 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 ❑ 1 ❑ A TAP 0 Road Mix Bituminous ❑ Dirt <br /> Elec ❑ 2 O C SIZE O Hot Mix Bituminous ❑ Gravel <br /> ❑ 5 ❑ E ❑ Portland Cement Concrete ❑ Oiled Earth <br /> Light/Traf.Cable ❑ 6 ❑ F ❑ Roadway ❑ Blvd. ❑ Walk ❑ Alley <br /> Other ❑ 8 O K <br /> Size Disturbed <br /> PIPE LENGTH ❑ 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 undersigned hereby requests permission to perform the work <br /> indicated above. <br /> MINNEGASCO, INC. XXXXMXMXXMXXXXXXXX <br /> (Sr. Design Engineer):i <br /> To the Minnesota Gas Company <br /> Permission is hereby granted the Minnesota Gas Company to perform <br /> the work indicated above. <br /> of <br /> Date By <br /> (Authorized Signature) <br /> FORM 45A R3/78 <br />