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MINNEGASCO SERVr,ICE INSTALLATION <br />� Map No. Natural Gas � Pr�pane Vapor ❑ Permit No. <br /> . Municipality ��.�.:���� Minneapolis � Order No. � �'�'� �`'� <br /> Folio No. Date Ord'sred � "'�' =x'�� E No. � <br /> Custorner's Name s�e1� �a P,�-�?��.�.•`„-i-� ��`' „i�;71���`tl-=i�'unc Tel. <br /> Installation Address ��"���`� ��'�-�����a` �`� Zip <br /> Liri�. f`"�`=`:�lock " 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 />* Surtacing",the most recent edition on file with the permitting authority. <br /> Install: Service Main Location <br /> Additional Info. <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 permissi4n to perform the work <br /> indicated above. <br /> MINNESOTA GAS COMPANY <br />` �.�(�! �-� � <br /> , �--�, <br /> (Chief Engineer) <br /> �_ <br /> il <br /> To the Minnesota Gas Company '� <br /> Permission is hereby granted the Minnesota Gas Company to perform the work <br /> indicated above. <br /> ,� ' p <br /> �__. <br /> - "- -�- + o f i :. �' ' <br /> Date �" ``�: �1�� By ' � ��' ., { � - '�- , <br /> � (Authorized Signature) <br /> ' Form 52 R 5178 <br />