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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas L] Propane Vapor ` _ ] Permit No. <br />Municipality Minneapolis 17-1 Order No. a - <br />Folio No. Date Ordered - E No. <br />Customer's Name i11a" s A lb eX t Tel. <br />Installation Address ' 1 a j co �'�yE Zip. <br />Lot 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: <br />Additional Info. <br />Date Completed <br />Service Main Location <br />To the (City Engineer <br />(City Council <br />(Village Council <br />(Town Board <br />Foreman's Name _ <br />Pressure Class <br />ThP Minnesota Gas Company hereby requests permission to perform the work <br />indicated above. <br />To the Minnesota Gas Company <br />MINNESOTA GAS COMPANY <br />n , ,; <br />1. y -L. - � - <br />(Chief Engineer) <br />Permission is hereby granted the Minnesota Gas Company to perform the work <br />indicated above. <br />Date _...�... <br />F of n, 52 H 5 78 <br />2 <br />of <br />(Author, -,ed Signature, <br />