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MINNEGASCO SERVICE INSTALLATION <br />Map No. 3 6 Natural Gas ❑ Propane Vapor 0 Permit No. <br />Municipality Orq;w Minneapolis O Order No. <br />Folio No. Date Ordered -4-s1 E No. L 10 <br />r <br />stomer's Name `�t'�'��«' Tel. <br />tallation Address ;35 remade xt"d Wet[ Zip <br />t 105 Block Addition Auci d kilo % fLi <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. 1111 5/$" PE 0/ 19(xZ) b" ST (1%2) 4ai8 <br />]<1 t.-13+ NCL Pressure Clasc `" ^ <br />Date Completed _. Forenvan'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 />'+3`I (Chief Engineer) <br />To the Minnesota Gas Cumpany <br />Permission is he,,:r:. gr.rmed thu Minnes-Aa Gas Lumpany to perform the work <br />indicated above. <br />of: <br />r <br />Date By ��L (, ..I� 14 1(�'•'� r <br />(Authorized Swriatt <br />Form 52 R 5/78 <br />