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Rec'd in Street <br />MUNICIPAL <br />MINNE GASCO PERMIT NO. <br />Mpls.0 SERVICE INSTALLATION ORDER NO. r <br />Sub. I E-NO. <br />Map No. Old❑ New❑ Bldg. Class ✓ <br />Customer's Name_ itiks 5OC,1316 Tel. <br />Installation Address tun i;tt}RCt—_ <br />Legal Description: Lot No. _� Block No. _ <br />-0- IM, 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 (] Left <br />A d'I Info. pqt, pr y&r-g mal11 ?9Wj1 Ina (1of,01 - — <br />Date Completed <br />To the (City Engineer <br />y )r <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 />Date <br />of <br />By <br />(Authorized Signature) <br />FORM 52-3R 6' 69 <br />