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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas ❑ Propane Vapor ❑ Permit No. <br />Municipality ___i)rAif141 Minneapolis ❑ Order No. 1.Q6 <br />Folio No. Date Ordered +0-7ce._ E No. <br />IL <br />stomer's Name Whinelcs► n -,, Tel. <br />nstallation Address ?14(} DP in iAny Zip <br />ot Block Addition t� = r s.% r v <br />Install <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 />Service <br />Main _ Location <br />Additional Info. <br />Pressure Class <br />uate uom <br />To the (City Engineer <br />(City Council <br />(Village Council <br />(Town Board <br />foreman"s Name _ <br />The Minnesota Gas Company hereby requests permission to perform the work <br />indicated above. <br />MINNESOTA GAS COMPANY <br />L L i• �- ? _ t - -v <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 />of <br />_y rono <br />Date By <br />(Au thbrized, Signature) <br />Form 52 R 5/78 <br />