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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas O Propane Vapor ❑ Permit No <br />Municipality r•Minneapolis C7 Order No <br />Folio No. Date Ordered ; Q-• E No <br />Customer's Name h n d raW A. K n l Tel. <br />Installation Address i ? t; r hr Ley C hac p fir Zip <br />Lot .;._ Block —Z Addition N 1 f 1 uw V Annn r <br />Method of Installation or Constiuction (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: Service Main Location <br />Additional Info. <br />Pressure Class <br />nate Completed <br />To the (City Engineer <br />(City Council <br />(Village Council <br />(Town Board <br />Foreman's Name <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 Company <br />Permission is hereby granted the Minnesota Gas Company to perform the work <br />indicated above. <br />of <br />Date By ' ��-• <br />(Authorixid Siy tura) <br />Form 52 R 5/78 <br />