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.� <br /> MINNESOTA GAS CO.MAINTENANCE ORDER NO. <br /> 0 MAIN O 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 <br /> 0 Road Mix Bituminous O Dirt <br /> Elec � 2 � C SIZE O Hot Mix Bituminous 0 Gravel <br /> � 5 � E O Portland Cement Concrete O Oiled Earth <br /> Light/Traf.Cable � 6 � F <br /> O 8 O K O Roadway � Blvd. � Walk � Alley <br /> Other <br /> Size Disturbed <br /> PIPE LENGTH O Same Ft. Longer Ft.Shorter Ft.Abandoned <br /> SERVICE TAP MEASUREMENT <br /> DATE STARTED 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. i <br /> !�/"( ;.`G�r<.,v� .✓/' <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 />