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MINNEGASCO SERVICE INSTALLATION <br />:�ut� <br />Map No. Natural Gas ❑ Propane Vapor ❑ Permit No. <br />Municipality C>rorir, '11.,oneapolis O Order No. <br />Folio No. Date Ordered h- ' 1-d5- E No. 11 j <br />ILns <br />stomer's Nme Poaints WLst Eldrs ,i,c Tel. <br />tallation Address7615 Countrvside DrZip <br />ot -' Block _� Addition <br />Install: <br />II f <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 />Servict Main Location <br />P%UUR ora n U. <br />Pressure Class <br />Date Completed Foreman's Name <br />To the {City Engineer <br />(City Council <br />(Village Council <br />(Town Board <br />Minnegasco Inc. hereby requests permission to perform the work indicated <br />above. <br />MINNEGASCO, INC. <br />t i+o.t <br />To Minnegasco, Inc. <br />Permission is hereby granted Minnegasco, Inc. to perform the workindicated <br />above j r <br />Date By <br />(Authorized Signature) <br />Form 52 A 5/78 <br />