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MINNEGASCO SERVICE INSTALLATION <br />Map No. _ Natural Gas 0 Propane "v'apor 0 Permit No. <br />Municipality r:I - Minneapolis a Order No. 4,' 1, <br />Folio No. Date Ordered .s_ E No. 2,T <br />Customer's Name r►a'r Tel. <br />Installation Address 4p4p 3i,os�o Zip. <br />Lot _�- Block __Addition <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: Service Main Location <br />Additional Info. <br />Pressure Class <br />Uate 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 />(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 />i tv of 0-rolic <br />_ 1 <br />4 <br />Date -� - B -- - <br />Y <br />(Au oriza8 Signature) <br />Form 52 8 5/78 <br />