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MINNEGASCO SERVICE INSTALLATION <br />-■ Natural Gas □ Propjne Vapor O Permit No----------— <br />Municipality ____________________ Minneapolis O Order No— <br />Folio No_________________________D'ite Ordr" Prill----------- E No— <br />Customer's Name LilHJ—tq_n-----------------------------------------------------jel. ---------- <br />Installation Address ^ I P- iiir*■ ----------------------------------------------- Zip ---------- <br />Lot Block _____ AHHitir^n JohfV-. t Of.s Rcof rcnq^iiPen t_________________ <br />Map No. <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 Main Location <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 />Qr/^l <br />X ■(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 />^ y' / /L <br />Date <br />-7.-------.-i <br />(Authorised Signature) <br />Form 52 R 5/78