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MINNESOTA GAS CO. MAINTENANCE <br />a MAINj^ SERVICE PAV. CUT NO;________ <br />.e«e«e- <br />LOCATION:2 5 10 Oaiee Point Rd <br />ORDER NO. <br />LEAK RPT NO. <br />RESP.ACCr NO <br />FPC - or E NO. <br />Tm <br />NATURE OF WORK <br />PB ?taia Cl-6 <br />ie»t «nvi tonu«ct 5/<i'' PE (H-JO) Serv to <br />K-Y97-TT <br />FOREIGN STRUCTURES PRESS. CL.NEW <br />Tele a 1 LD A TAP <br />CaU. <br />Elec □ 2 a c <br />a 5 a E <br />SIZE <br />Light/Traf. Cable a 6 □ F <br />Other D 8 D K <br />SURFACE DISTURBED <br />Q Road Mix Bituminous O Dirt <br />D Hot Mix Bituminous [T Graval <br />O Portland Cement Concrete O Oiled Earth <br />O Roadiivav □ Blvd. [□ Walk O Alley <br />Sire Disturbed <br />PIPE LENGTH (□ Same _ Ft Loneer Ft Shorter Ft Abandoned <br />StRVICE 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 CourKil <br />(Town Board <br />The undersigned heredy requests permission to perform the work <br />indicated above. <br />MINNESOTA GAgCOMPANY <br />Rw Q I <br />(Authorized Signature) <br />To the Minnesota G» Comp«ty <br />Permission is hereby granted the Minnesota Gas Company to per form <br />the ¥Hiork indicated above. <br />'L <br />Dete. <br />(Aiithon/pfl Stgnaturft <br />FORM 46A ns/rt