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MINNEGASCO SERVICE INSTALLATION <br />Map No. Naturcl Gas El Propane Vapor ❑ Permit No. <br />Municipality—i��' Minneapolis Cz7 Order No. �� <br />Folio No. Date Ordered E No. <br />Customer's Name ingew�oo ;x�st <br />'93s�C,�F.:YT ess Tel. <br />InstallAddress - Zip <br />lot Block- Addition <br />Method of Installation or Construction (including method of compaction <br />ant: 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 />uate t.:orn <br />To the (City Engineer <br />(City Council <br />(Village Council <br />(Town Board <br />To the Minnesota Gas Company <br />Foreman's Name <br />.: f f <br />-IF -kjim <br />V 1P W W 0 W 0 W W Wi <br />10. <br />Permission is hereby granted the Minnesota Gas Company to perform the work <br />indicated above. i Ot <br />f 1 <br />Date <br />Form 52 R 5/78 <br />By. _= <br />(Authorized Signature) <br />,a• <br />