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MINNESOTA GAS CO. MAINTENANCE <br />❑ MAIN SERVICE P.C. NO�r, <br />DATE ? 7 MUNIC.0 ron0 <br />LOCATION: 2765 F')X Street' <br />NATURE OF WORK Repair service <br />ORDER NO. <br />NARUC OR E NO. <br />RESP. ACCT. NO. <br />FOREIGN STRUC. PRESS. CL. SURFACE DISTURBED PIPE LENGTH <br />TELE a 1 ❑ ASPHALT ❑ OIL ❑ SAME <br />ELEC ❑ 3 ❑ CONCRETE ❑ DIRT FT LONGER <br />WU ❑ 3 ❑ BLVD ❑ WALK ❑ ALLEY FT SHORTER <br />OTHER ❑ 6 SIZE DISTURBED FT ABANDONED <br />SERVICE TAP MEASUREMENT <br />DATE STARTED �+ — 'DATE COMPLETED 3`" FOREMAN <br />To the (City Engineer <br />(City Council <br />(Village Council <br />(Town Board <br />The undersigned hereby requests permission to perform the work <br />indicated above. <br />MINNESOTA GAS COMPANY <br />By Q / <br />(Authorized Signature) <br />To the Minnesota Gas Company <br />Permission is hereby granted the Minnesota Gas Company to perform <br />the work indicated above. <br />Date <br />t. , <br />By; <br />(Authorized Signature) <br />Form 45A R 1 1 /71 <br />