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MINNEGASCO SERVICE INSTALLATION <br /> Map No. Natural Gas ❑ Propane Vapor ❑ Permit No. <br />< Municipality ,�,t,y,.�-;� Minneapolis � OrderNo. <br /> _ �'-���`';��'s <br /> Folio No, Date Ordered �� �,� E No. ` - <br /> Customer's Name ;:�,,�-,� �� ��,� Tel. <br /> . �_-,...`���..�_e <br /> Installation Address � ; a,.,,.�� �� Zip <br /> � ` <br /> Lot,�,T.�._Block � Addition v _� <br /> "_M�- ` <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 /> Surtacing",the most recent edition on file with the permitting authority. <br /> Install: Service_T..Main Location <br /> ' Additional �nfo. <br /> Pressure Class <br /> Date 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 /> ,��-:�-!'��,,w--.. ,�./ _ <br /> (Chief Engineer) <br /> �_ <br /> To the Minnesota Gas Company <br /> Permission is hereby granted the Mirinesota Gas Company to perform the work <br /> indicated above. <br /> of " ° <br /> Date '- ` . By- _;- . . - <br /> r - f,4uthorized Signature) <br /> Form 52 R 5/78 <br />