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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas ❑ Propane Vapor FJ Permit No <br />Municipality CrQua Minneapolis C] Order No <br />Folio No. Date Ordered E No <br />storner's Narne Tel, <br />lLot <br />nstallation Address Q�,"� Zip Block Addition Jnhr.stans Rvarrant:er.,Ant <br />Method of Installation or Construction (including mf -hod 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 Completed Foreman's Name <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 />r <br />(Chief Engineerl <br />To the Minnesota Gas Company <br />Permission is hereby granted the Minnesota Gas Company n the work <br />indicated above. <br />Date �y' L By <br />(Authorized Signature) <br />i <br />Form 52 A 5/78 <br />