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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas ❑ Propane Vapor 0 Permit No. <br />Municipa;ity Minneapolis O Order No. llSIU <br />Folio No. Date Ordered _ E No. sit <br />Cust,wwr's Name J1 u_ i 1 uc r i Tal, <br />Installation Address Lar St Zip. <br />Lot 6 Block Addition 'r'ysstn ,li <br />Method of Installation or Construction (including method of compaction <br />and excavation) will be in accordance with procedures as described in <br />Minnegasco Operations Manual, Section 500, "Excavatinq, Backfilling and <br />Surfacing", the most recent edition on file with the permitting authority. <br />Install: <br />Additional Info <br />Service Main Location <br />Pressure Class <br />Date Completed Foreman's Name <br />To the (City Engineer <br />(City Council <br />(Village Council <br />(Town Board <br />The Minnesota Gas Company hereby requests permission to perform the work <br />indicated above. <br />MINNESOTA GAS COMPANY <br />(Chest Enginetr) <br />To the Minnesota Gas Company <br />Permission is hereby granted the Minnesota Gas Company to perform the work <br />indicated above. <br />of <br />Date By <br />[Authorized S1gnaturs) <br />