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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas ❑ Propane Vapor ❑ Permit No. <br />Municipality r,r r)tjn Minneapolis El Order No. 1 L"C"C. <br />Folio No. Date Ordered -�`-�' E No. t. <br />[,Lot <br />storneisName[ _n nc4-r i : i t : r v. TQI. <br />nstallation Address A?:._tom F �. } ^ r• ►, r. n Zip <br />Block Addition g 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 <br />Additional Info. <br />uate uom <br />To the (City Engineer <br />(City Council <br />(Village Council <br />(Town Board <br />Main Location <br />Foreman's Name <br />Pressure Class <br />i he Minnesota Gas Company hereby requests permissi perform the work <br />indicated above. <br />MINNESOTA GAS COMPANY <br />y� <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 By��1 ttzlA <br />f <br />(Authorized et re) <br />Form 52 R 5/78 <br />