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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas O Propane Vapor ❑ Permit No. <br />Municipality 0ronn Minneapolis O Order No. <br />Folio No. Date Ordered — 0 E No <br />lLot <br />ustomer's Name G re-6 r r i c e� —Tel. <br />nstallation Address � Fare-s Arm LL��e Zip Block Addition Forest : s rms <br />_�0 <br />Method of Installation or Construction (including method of compaction <br />and excavation) will be in accordance with procedures as described tr+ <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 <br />Additional Info <br />Pressure Cass <br />Location <br />Uate uom leted 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 abov-3. <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 />Date ;__i — _ By 4' N <br />(Aut riled S.Ignature) <br />Form E2 R 5 78 <br />