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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas ❑ Propane Vapor ❑ Permit No. <br />Municipality - U ren g Minneapolis El Order No. 61bl <br />Folio No. Date Ordered ' �-1-7Cj E No.D <br />Customer's Name - Dale ' h r i% t n g n n Tel . <br />1nstiiiation Address 27,0 Casco Po i ri r ;1na! Zip <br />Lot Block _...3_ Addition Ir r' <, <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: Service Main Location <br />Additional Info. <br />Pressure Class <br />Date Completed 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 the work <br />indicated above. <br />MINNESOTA GAS COMPANY <br />!Chief Engineer) <br />To the Minnesota Gas Company <br />omission is hereby granted the Minnesota Gas Company to perform the work <br />indicated above. <br />, <br />of <br />�: j .— i B tom - <br />Date y - - <br />�r �W <br />(Authorized $igneture) <br />Form 52 R 5/78 <br />