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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas O Propane Vapor O Permit No. <br />f Municipality nrnnn Minneapolis O Order No. 67.62 <br />Folio No. Date Ordered 10-1-72 E No. 3n <br />Customer's Name Theodore W_ Roer Tel. <br />Installation Address 1392 $:D I rlu r Pork Road Zip 1 <br />Lot 17 Block I_ Addition gaidur Park <br />Method of Installation or Construction (including method of compaction <br />and excav^",on) will be in accordance with procedures as described in <br />Minnegasco Operations Manual, Section 500, "Excavating, Backfilling and <br />Surfacing", the most recent edition on file with the permitting authority. <br />Install: Service Main Location <br />Additional Info. <br />Pressure Class <br />�Me %.umaieiea <br />To the (City Engineer <br />(City Council <br />(Village Council <br />(Town Board <br />rureman s Ndme <br />The Minnesota Gas Company hereby requests permission to perform the work <br />indicated above. <br />MINNESOTA GAS COMPANY <br />(Chief Engineer) <br />La <br />To the Minnesota Gas Company <br />Permission is hereby granted the Minnesota Gas Company to perform the work <br />indicated above. <br />U 1 uy of uronn <br />Date 1 0-1 ? —70_ By �., �! •r <br />(Authorize Signature) <br />Form 52 R 5/78 ` <br />