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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas ❑ Propane Vapor ❑ Permit No. <br />Municipality U ro«U Minneapolis D Oroer No. 6081 <br />Folio No. Date Ordered 1 U-21 E No. jD <br />lLot <br />ustomer's Name - y4wa r d T a Y I G rTel. <br />rlttallation Address 123 Che�fy Lhasg Drive Zip <br />12 Block Addition <br />Method of Installation or Construction (including method of compaction <br />and excavation) will be in accordance with procedures as described 'Ll <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 <br />Pressure Class <br />Date Completed Foreman's Name <br />To the (City Engineer <br />(City Council <br />(Village Council <br />(Town Board <br />Location <br />The Minnesota Gas Company hereby requests permission to perform the work <br />indicated above. <br />MINNESOTA GAS COMFANY <br />(Chief Engineer) <br />To the Minnesota Gas Company <br />Permission is hereby granted the Minnesota Gas Company to perform the %vork <br />indicated above. <br />Date : <br />Form 52 R 5/78 <br />City —of Orono <br />(Authorized Signature) <br />