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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas ❑ Propane Vapor ❑ Permit No. <br />Municipality 0 rono Minneapolis ❑ Order No. 26344 <br />Folio No. Date Ordered 4 —2 %— i 9 E No. 30 <br />Customer's Name Tom Mortenson Tel. <br />Installation Address 1971 FaUerness Pt Rd Zip. <br />Lot 6 Block Addition F a a e r n e s s Act <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 />� 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 />Date <br />ey <br />(Au thorizect SigWure) <br />Form 52 R 5/76 <br />