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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas ❑ Propane Vapor ❑ Permit No. <br />Municipality __..rs)rii2 Minneapolis El Order No. <br />Folio No. Date Ordered E No. 3 <br />Customer's Name i t ,;A in,;4 n Tel. <br />Installation Address 214ftill Zip. <br />Lot _ Block Addition 1 a li Ana n A rl d <br />Address i,: 2LL'70 Carma <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 <br />Main Location <br />Additional Info. <br />Pressure ,'.lass <br />Date Completed t-oreman-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 />Whief Engineer) <br />To the Minnesota Gas Company <br />Permission is hereby granted the Minnesota Gas Company to perform the work <br />indicated above. <br />o1 <br />r <br />Date - - <br />Form 52 A 5/78 <br />Signature) <br />