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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas ❑ Propane Vapor ❑ Permit No, <br />Municipality Q rnnr, Minneapolis El Order No, <br />Folio No. Date OrderedE No, <br />Customer's Name f 1-1„r r . R I ra Ims•r_.�I i Tel. <br />Installation Address IL;,..._C y gne t P l ar" Zip <br />Lot Block Addition Swnn i atr,- <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 <br />Additional Info <br />Service <br />Main <br />Pressure Class <br />Uate CAmpletea roreman s rvame <br />To the (City Engineer <br />(City Council <br />(Village Council <br />(Town Board <br />Location <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 />Date By <br />(Authorized Signature) <br />Form 52 R 5/78 <br />