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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas ❑ Propane Vapor C� Permit No <br />Municipality 0 rnn Minneapolis El Order No <br />Folio No. Date Ordered i E No <br />Customer's Name T hrifn a c C i cwe I I Tel. <br />Installation Address I? Q C hp uv CI- i s i- h L I 'JP Zip <br />Lot Block % Addition H i I I n.,:; Manar <br />Method of Installation or Construction (including 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: <br />Additional Info. <br />Service Main _ Location <br />Pressure Class <br />vdie %,urnuieteu rure111dii a ivdnir <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 Engineer) <br />To the Minnesota Gas Compaq <br />Permission is hereby granted the Minnesota Gas Company to perform the work <br />indicated above. <br />Date 1 !) _Q,_7.() - <br />Form 52 R 5/78 <br />City o f <br />By Z.4 <br />(Authorized Signature) I <br />