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MINNESOTA GAS CO. MAINTENANCE ORDER NO. <br />❑ MAIN LZI SERVICE P.C. NO. NARUC OR E NO. <br />DATE _ MUNIC. RESP. ACCT. NO. <br />LOCATION:_ <br />NATURE OF WORK <br />FOREIGN STRUC. <br />PRESS. CL. <br />SURFACE DISTURBED <br />PIPE LENGTH <br />TELE <br />❑❑ 1 <br />❑ ASPHALT ❑ OIL <br />❑ SAME <br />ELEC <br />❑ 3 <br />❑ CONCRETE ❑ DIRT <br />FT LONGER <br />❑ s <br />— <br />wU <br />❑ S <br />❑ ■LVO ❑ WALK ❑ ALLEY <br />FT SHCIVITER <br />OTHER <br />❑ e <br />SIZE DISTURBED <br />FT A1IANOONED <br />SERVICE TAP MEASUREMENT <br />I <br />DATE STARTED DATE COMPLETED FOREMAN <br />To the (City Engineer <br />(City Council <br />(Village Council <br />ITown Board <br />The undersigned hereby requests permission to perform the work <br />indicated above. <br />MINNESOTA GAS COMPANY <br />By <br />(Authorized Signature) <br />To the Minnewta Gas Company <br />Permission is hereby granted the Minnesota Gas Company to perform <br />the work indicated above. <br />of <br />Date By <br />(Authorized Signature) <br />Form 45A R 11/71 <br />