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Rec"d in Street MUNICIPAL <br />MINNEGASCO PERMIT NO. <br />MPIs. SERVICE INSTALLATION ORDER NO. �. <br />Sub-- Mr E-NO. <br />Map NQ. _ Ojd❑ Now[] Bldg. Class <br />Customer's Name Tel. <br />Installation Address;; " <br />Legal De .cription: Lot No. s: Block No. _ <br />w Ae ition <br />Contr's Name _ Tel. <br />Contr's Address <br />Owner's Name Tel. <br />Owner's Address <br />Date Ordered x� Max. Demand CF/Hr. Taken By <br />Main Auth. No. Service Location: Right ❑ Left ❑i Front ❑ <br />Add' I Info. „ :-u T .•f + • I r� I S ° �'•, a� r , _; ? , ;, <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 <br />the work indicated above. <br />MINNESOTA GAS COMPANY <br />u ( <br />(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 />(Authorized Signature) <br />FORM 52-9R 8169 <br />