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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas D Propane Vapor ❑ Permit No. <br />Municipalitv Jr44'..Q_ Minneapolis 0 Order No. 2f12V7 <br />Folio No. Date Ordered 1p-a�-7_ E No. �4 <br />IL <br />stomer's Name dorru--9artia <br />nstallation Address �6 L_cqdilo 1;t�d Not Block Addition Pa rye l 4410 <br />Tel. <br />Zip <br />Method of Installation or Construction (including method of compaction <br />and excavation) will be in accordance with procedures as described in <br />Minnegasco Op..- -`ion-, Manual, Section 500, "Excavating, Backfilling and <br />Surfacing", the most recent edition on file with the permitting authority. <br />Install: Service Main <br />Additional Info <br />uate UomDieted <br />To the (City Engineer <br />(City Council <br />(Village Council <br />(Town Board <br />F-oreman's Name <br />Pressure Class <br />Lccation <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 />�' 1t of ,L c�r> C, <br />Date <br />By, 1 _i.zC' i' .,t 1 • ;' r 3 " <br />' <br />(Authorized Signature) <br />Form 52 R 5/78 <br />