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MINNESOTA GAS CO. MAINTENANCE <br />□ MAIN CDSERVICE PAV.CUTNO;________ <br />DATE 5-27-83_____MUNic. Qrono <br />ORDER NO. 55Qn <br />LEAK RPT. NO.________ <br />resp .acct.no.______ <br />FPC • or • E NO. 892 <br />LOCATION:1376 Bcildur Park Hoad <br />1 <br />NATURE OF WORK Pcnnir .SarvicG i <br />) .... <br />FOREIGN STRUCTURES PRESS. CL.NEW SURFACE DISTURBED <br />Tc!e 0 t □ A TAP CD Rood Mix Bituminout CD Dirt <br />£loc <br />az □ c <br />n s i~i E <br />SIZE Q Hot Mix Bituminous (□ Grovel <br />□ Portland Comont Concrete LJ Oiled Earth <br />Light/Traf. Cable □ 6 (□ F □ Roadway O Dtvd. CD Walk O Alley <br />Other <br />i’-'i 8 1 I JC ;Sijro Disturbed <br />PIPE LENGTH D S«mo Ft. Longer Ft. Shoriof Ft. Abandoned <br />SERVICE TAP MEASUREMENT <br />DATE STARTED 3 79 ^3 COMPLETED FOREMAN rv-^^>^^pg <br />TRUCK TOWN NO. FOREMANS P.R. NO. - <br />To the (City Engineer <br />(City Council <br />(Village Council <br />(Town Doard <br />The undersigned hereby requests permission to perform the work <br />indicated above. <br />MINNEGASCO. INC. <br />(Sr. Design Engineer) <-/ <br />To the Minnesota Gas Company * <br />Permission is hereby granted the Minnesota Gas Company to perform <br />the work indicated above. <br />r::L of, <br />D«. <br />_;J/ C i,/ / <br />. / <br />(Authorized Signature) <br />FORM 45A R3/78