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MINNEGASCO SERVICE INSTALLATION <br />Map No. t Natural Gas ❑ Propane Vapor D Permit No, <br />Municipality C Minneapolis C7 Order No, <br />Folio No. Date Ordered E No. <br />IL <br />stomer's Name - Tel. <br />nstallation Address 95j';4� _ r Zip <br />ot ,.� Block __ Addition �•;rEa�:. !1z iii�: <br />In II <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 />Service Main <br />At tional Info. <br />Pressure Class <br />Date Lompietea <br />To the (City Engineer <br />(City Council <br />(Village Council <br />(Town Board <br />f-oreman's Name <br />Location <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 />1.� of 1.4...� <br />Date .. -- By <br />(Authorized Sjgn <br />Form 52 R 5/78 <br />