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MINNEGASCO SERVICE INSTALLATION <br />______— Natural Gas Q Propane Vapor O Permit No. <br />^i'Ynyy? Minneapolis O Order No. <br />___________________Date Ordered g . ^ <br />Customer's Name ____________7el. <br />■ « r f SI 7^. \ » <br />-------------------------- Zip <br />Map No. _ <br />Municipality <br />Folio No__ <br />Installation Address <br />Lot _____Block «. <br />XT r'. X\ ^^ <br />.^1 Id-: <br />?I • <br />Addition <br />Method of Installation or Construction (mciuding method of compaction <br />and excavation) will be in accordance with procedures as described in <br />Minnegasco Operations Manual, Section GOO, "Excavating, Ba:kfilling and <br />Surfacing", the most recent edition on file with the permitting authority. <br />Install: ......... <br />Additional Info. <br />Service .Main Location <br />V ^ * <br />Pressure Class <br />Date Completed Foreman's Naine <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 />MINNEGASCO. INC. <br />(Sr Oeaign Engineer) <br />iI <br />To the Minnesota Gas Company <br />Permission is hereby granted the Minrresota Gas Cbmpany to perform the work <br />indicated above./ P J ■ <br />/ '■ _ r-/ L. ^ <br />(/;'// '' '/ ' /'■' / . <br />/ ' V'' ^ ' 7 <br />M Signar r ’ <br />Form b2 R 5/7f