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Rec'd in Street <br />MINNEGASCO <br />MpIs.f-1 SERVICE INSTALLATION <br />Sub. <br />Map No. Old ❑ <br />Customer's Name <br />Installation Address <br />Legal Description: Lot No. <br />MUNICIPAL <br />PERMIT NO. <br />ORDER NO. <br />E-NO. <br />New❑ Bldg. Class <br />Tel. <br />Block No. <br />Addition <br />Contr's Name Tel. <br />Contr's Address <br />Owner's Name Tel. <br />Owner's Address <br />Date Ordered Max. Demand CF "Hr. Taken By <br />Main Auth. No. Service Location: Right LeftEl Front <br />Add' I Info. <br />Date Completed <br />To the (City Engineer *�=�► <br />(City Council <br />(Village Council <br />(Town Board <br />Foreman's Name <br />The Minneapolis Gas Company hereby requests permission to perform <br />the work indicated above. <br />MINN EAPOL IS GAS COMPANY <br />(Chief Design Engineer) <br />To the Minneapolis Gas Company <br />Permission is hereby granted the Minneapolis Gas Company to perform <br />the work indicated above. <br />of <br />Date By <br />(Authorized Signature) <br />FORM 52-3R 6/ 69 <br />