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Recd in Street <br />MINN EGASCO <br />MplsSERVICE INSTALLATION <br />Sub. <br />Map No. <br />Customer's Name <br />Installation Address <br />Old❑ New❑ Bldg. <br />130'r ±- Nf�'ac <br />Legal Description: Lot No. Block No. <br />MUNICIPAL <br />PERMIT NO. <br />ORDERN0. —" -1 -" <br />E -N 0. <br />Class <br />Tel. <br />Addition <br />Contr's Name Tel. <br />Contr's Address <br />Owner's Name____ Tel. <br />Owner's Address <br />Date Ordered Max. Demand CF Hr. Taken By <br />Main Auth. No. Service Location: Right ❑ Left ❑ Front <br />Add'I Info. 3J8" P9 Serv. _ !t' ShLtng-(14n7) <br />t <br />f%1 r- aria <br />Date Completed Foreman's Name <br />To the (City Engineer ., r <br />(City Council <br />(Village Council <br />(Town Board <br />The Minneapolis Gas Company hereby requests permission to perform <br />the work indicated above. <br />MINNEAPOLIS GAS C:-IMPANY <br />f.' f <br />(Chief Design Engineer) <br />To the Minneapolis Gas Company <br />Permission is hereby granted the Minneapolis Gas Company to perform <br />the work indicated above. <br />of <br />Date_ By ----.— — <br />(Authorized Signature) <br />FORM 52-3R I 69 <br />