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Rec'd in Street MUNICIPAL <br />MINNEGASCO PERMIT NO. <br />MPIs.❑ SERVICE INSTALLATION ORDER NO. <br />Sub. OR -ONO E-NO. <br />_Mop No. A10 Old❑ New❑ Bldg. Class <br />Customer's Name Ya=—:sckhci.itit $?A=rt Tel. <br />Installation Address T1 rfitbsi & <br />Legal Description: Lot No. 31-11 Block No. <br />tom- Addition <br />Contr's Name Tel. <br />Contr's Address <br />Owner's Nome_ _ Tel. <br />Owner's Address <br />Date Ordered i 1 4#ax. Demand CF/Hr. Taken By <br />Main Auth. No. Service Location: Right ❑ Left ❑ Front ❑ <br />A dd' I Info. <br />Date Completed <br />Foreman's Name <br />To the (City Engineer Xx <br />(City Council CALL <br />(Village Council <br />(Town Board <br />The Minnesota Gas Company hereby requests permission to perform <br />the work indicated above. <br />MINNESOTA GAS COMPANY <br />352 (Chief Design Engineer) <br />To the Minnesota Gas Company <br />Permission is hereby granted the Minnesota Gas Company to perform <br />the work indicated above. <br />of <br />Date By <br />(Authwis Signature) <br />FORM 62-3R 6169 <br />