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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas ❑ Propane Vapor ❑ Permit No <br />Municipality n r-inn Minneapolis Cl Order No <br />Folio No. Date Ordered 11l-1E No <br />Customer's Name E.-Elnu F rye r Tel. <br />Installation Address r C ry c tom, l ► n:k R r,ad Zip <br />Lot Block Addition 7cyrniA i tF, of I_ jjnQdnn Pk <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: Service Main Location <br />Additional Info. <br />Pressure Class <br />Date Gomoleted <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 />/ I - A. <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 />Date <br />1 0 -1 "' y <br />i t; it of <br />gy <br />(Authorized, Signature) <br />Orono <br />Form 52 R 5/78 <br />