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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas ❑ Propane Vapor ❑ Permit No. <br />Municipality Orono Minneapolis 0 Order No. 1 <br />Folio No. Date Ordered _ z 3 _ E No. <br />Customer's Name James Dongoske Tel. <br />Installation Address S60 forest f+rms Zip <br />Lot Block I Addition 5 1A r rr: <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: <br />Additional Info <br />Date Com .,!ted <br />Service Main <br />To the (City Engineer <br />(City Council <br />(Village Council <br />(Town Board <br />Foreman's Name <br />Location <br />Pressure Class _ <br />The Minnesota Gas Company hereby requests permission to perform the work <br />indicated above. <br />MINNESOTA GAS COMPANY <br />(Chief Enginee- <br />To the Minnesota Gas Company <br />Permission is hereby granted the Minnesota Gas Company to perform the work <br />indicated above. <br />of <br />Date By <br />Form 52 R 5/78 <br />