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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas ❑ Propane Vapor ❑ Permit No <br />Municipality Lit.—aiJ Minneapolis 0 Order No <br />Folio No. Date Ordered • ' - 1 E No <br />1Customer's Name Gresyor4 1 tha.! r Tel. <br />Installation Address I P- 1, % 11 se * P 1 d�u Zip <br />Lot ii Block �_ Addition SWant=Leg Alddr. <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 <br />Additional Info. <br />Main Location <br />Pressure Class <br />LJa IC VVIIIIJIU Cu rureman s ivame <br />To the (City Engineer <br />(City Council <br />(Village Council <br />(Town Board <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 />C l t —of 01 <br />Date 8 _21 �. By 72 <br />(Authorl/ed Signature) <br />l <br />Form 52 R 5/78 <br />