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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas O Propane Vapor D Permit No. <br />Municipality - Minneapolis O Order No. 3� 1 `= <br />Folio No. Date OrderedE No. .3 <br />Customer's Name 14atu1rlsiu Tel. <br />Installation Address I QQ Cha w u=..0 r Zip. <br />Lot _ Block _I Addition <br />Method of Installation or Construction .ncluding 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 <br />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 Enaineer) <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 />Form 52 R 5/78 <br />By <br />of <br />'Authorized Sifineture) <br />