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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas 0 Propane Vapor 0 Permit No. <br />Municipality �. UR+7Kp Minneapolis 0 Order No. 8442 <br />Folio No. Date Ordered E No. Ju46 <br />ICustomer's Name Uau+d Jar.Ves Tel. <br />Installation Address l 8a�Fox R i AgeRri Zip <br />Lot ..�.._ Block_ 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 Main Location <br />Additional Info. <br />___.Pressure Class <br />Uate Completed 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 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 />of <br />Date I ^� ` i - `,� j By �- / <br />(Authorized Sirature <br />Form 52 R 5/76 <br />