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Rec'd in Street MUNICIPAL <br />MINNEGASCO PERMIT NO. <br />Mpls.❑ SERVICE INSTALLATION ORDER NO. <br />Sub. E -NO. <br />Map No. Old❑ New❑ Bldg. Class <br />Customer's Name Tel. <br />Installation Address <br />Legal Dese,iption: Lot No. Block Block No. <br />Addition <br />Contr's Name Tel. <br />Contr's Address <br />Owner's Nome__ <br />Owner's Address <br />Date Ordered Max. Demand CF/Hr. Taken By <br />Main Auth. No. Service Location: Right ❑ Left ❑ Front ❑ <br />Add' I Info. <br />T-;. <br />Date Completed <br />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 Engineer) <br />To the Minnesota Gas Company <br />Permission is hereby granted the Minnesota Gas Company to perform <br />the work indicated above. <br />Date <br />FORM !2-3a e, es <br />By <br />of <br />(At*herised Signwwo) <br />