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Recd in Street <br />MINNEGASCO <br />MUNICIPAL <br />PERMIT NO. <br />MPIs.❑ SERVICE INSTALLATION ORDER NO. <br />Sub. E -NO. <br />Map No. Old[] New❑ Bldg. Class <br />Customer's Nome 40 is i ,_: -o- Tel. <br />Installation Address 4b -- <br />Legal Description: Lot No. Block No. <br />Contr's Name ;.*w.. �.,..vF. <br />Tel. <br />Addition) <br />Contr's Address <br />Owner's Name_ Tel. <br />Owner's Address <br />Dote Ordered Max. Demand CF/Hr. Taken By <br />Main Auth. No. Service Location: Right ❑ Left ❑ Front E] <br />Add' I Info. <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 <br />the work indicated above. <br />MINNESOTA GAS COMPANY <br />(Chid Design Ensins+w) <br />To the Minnesota Gas Company <br />Permission is hereby granted the Minnesota Gas Company to perform <br />the work indicated above. <br />Dote <br />FORM $I -SR {/ N <br />of <br />By <br />(Authwized Slsneture) <br />