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Map No __ <br />Municipality <br />Folio No.__ <br />MINNEGASCO SERVICE INSTALLATION <br />Natural Gas □ Propane Vapor □ Permit No. <br />npr.M(!__ Minneapolis CD <br />Date Ordered A. - /.H <br />^ ? ri 1 rr rCustomer's Name _ _____________ <br />Installation Address ?A77 ^ <br />Lot 1 35i— Block ----------Addition_______ <br />Order No. 11 <br />___E No. ^0 <br />.Tel. ____________ <br />Zip. <br />Sp ring <br />Method of Installation or Construction (including method of compaction <br />and excavation) wiM 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 />Service Main Location <br />Pressure Class <br />Date Completed Foreman's Name <br />To the (City Engineer <br />(City Council <br />(Village Council <br />(Town Bon’d <br />The Minnesota Gas Company hereby requests permission to perform the work <br />indicated above. <br />MINNESOTA GAS COMPANY <br />_________________________________________(Chief Engineer) <br />To the Minnesota Gas Company <br />Permission is hereby granted the Minnesota Gas Company to perform the work <br />indicated above. .. , <br />Date 6 /-7 s rf 7 <br />(Authorized Signatured <br />Form 52 R 5/7t