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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas O Propane Vapor a Permit No. <br />Municipality 0 rants Minneapolis O Order No. 3879 <br />Folio No. Date Ordered 6-24-30 E No. 7r.. 4_ <br />Customer's Name `grin Adams Tel. <br />Installation Address yl r Fc)res t Arms Lane Zip <br />Lot _�_ Block �_ AdditionCountry. <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 Locatior <br />Additional Info. <br />Pressure Class <br />LJOLU Vu111UMMU rul ulliall J I14Al11C <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 />(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 />i r ...of f '�tc <br />Date _r �` By <br />r- 4 <br />(Authorized Signature) <br />Form 52 R 5/78 <br />