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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas 0 Propane Vapor ❑ Permit No. I <br />' Municipality Orono Minneapolis D Order No. 15531 <br />Folio No. Date Ordered — — E No. 30 <br />Customer's Name '�CUU11V QQn!8 h. �. Tel. <br />Installation Address 1Q Fox Sis <br />Zip <br />Installation <br />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 />ucite %,-Umpleteu <br />To the (City Engineer <br />(City Council <br />(Village Council <br />(Town Board <br />r-oreman's Name <br />The Minnesota Gas Company hereby requests permission to perform the work <br />indicated above. <br />MINNESOTA GAS COMPANY <br />P <br />r., <br />i (Chief Engineer) <br />(i <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 By <br />(Authorized Si nature) <br />Form 52 R 5/78 <br />