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r <br />Map No. <br />Municipality <br />Folio No. ___ <br />MINNEGASCO SERVICE INSTALLATION <br />_ Natural Gas Q Propane Vapor □ Permit No. <br />...... ......Minneapolis O Order No. <br />I ■ ■ ■ .1 . Date Ordered E No. '<i‘ <br />Customer's Name <br />Installation Addren <br />Lot, Block - <br />\L'jf\ rh^r rKj £1 <br />Tel. <br />Zip. <br />Addition CuL ■t. ^ V/Mmtt. <br />Method of Installation or Construction (including method of compaction <br />and excavation) will be in accordarKe 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 />_________________________________________/ (Chitf EnpiftMr) <br />r / <br />To the Minnesota Gas Company <br />Permission is hereby granted the Minnesota Gas Company to perform the work <br />indicated above. <br />Date <br />(Authorized Signaturel <br />Form 92 S/78