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rr Z0 ^ * WT-’rrr—p*..ir--'^<n<.Tw^ rf7:WTw. »-T-»-*K«v^ ' <br />MINNESOTA GAS CO. MAINTENANCE <br />a MAIN (59 SERVICE PAV. CUT NO. <br />DATE 1 7- 1 a- ?q MUNIC. Qronn <br />ORDER NO. <br />LEAK RPT. NO. <br />RESP. ACCT NO. <br />FPC • Of - E NO. <br />8706 <br />LOCATION !lSX W '^01^ C n f o Point Ho ij d <br />892 <br />NATURE OF WORK R p> p a t r S r v I r <br />FOREIGN STRUCTURES PRESS. CL.NEW <br />T«i«CD 1 n A TAP <br />Elec CD 2 CD c <br />r~l f% n c <br />SIZE <br />3 1__1 k- <br />LIght/Traf. Cable a 6 □ F <br />Other <br />a 8 a K <br />SURFACE DISTURBED <br />O Road Mix Bitummout <br />O Hot Mix Bituminous <br />[□ Portland Cement Concrete <br />□ Dirt <br />O Gravel <br />CD Oiled Earth <br />CD Roadway CD Blvd CD Walk CD Alley <br />Si/e Disturbed <br />PIPE LENGTH CD Same Ft. Longer Ft Shorter Ft. Abandoned <br />SERVICE TAP MEASUREMENT <br />DATE STARTED <br />TRUCK NO. ___ <br />COMPLETED | p _ ^ ^ ^ p FOREMAN <br />TOWN NO______________FOREMANS P.R. NO. _________ <br />i-Uii <br />Toth* (City Engin««r <br />(City Council <br />(Village Council <br />(Town Board <br />■ <br />■ <br />The ursdert^ed hereby requests permission to perform the work <br />indiceled above. <br />MINNESOTA GA$COMPANY <br />/J (Authofi/ed Signature) <br />To the Minrseeote Get Company i <br />Parmtwion ia h*r*tiy granted th* Minnetota Ga* (^mpany to perform <br />the work irnliceted above.i <br />0... 7T 1*1 . . .. .1 .L <br />(Authorised Signature) <br />■4 <br />FORM 4iA R3/7i