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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas D Propane Vapor O Permit No. <br />Municipality,; Minneapolis 0 Order No. <br />Folio No. Date Ordered E No. <br />Customer's Name 41 ma" - Tel. <br />Installation Address Zip. <br />Lot a Block _}_Addition <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, "Excavating, Backfilling and <br />Surfacing", the most recent edition on file with the permitting authority. <br />Install: Service Main <br />Additional Info. <br />Pressure Class <br />Location <br />Oate 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 derform the work <br />indicated above. <br />MINNESOTA GAS COMPANY <br />n/ r <br />7 (Chief Engineer) <br />To the Minnesota Gas Company <br />Permission is hereby granted the Minnesota Gas Company to perform the work <br />indicated above. <br />of ^�CytlC� <br />;J <br />Date By <br />lAuthori:ed Signature) <br />1 71 <br />