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� <br /> MINNESOTA GAS CO.MAINTENANCE ORDER NO. <br /> O MAIN O SERVICE PAV.CUT NO. LEAK RPT.NO. <br /> DATE MUNIC. RESP.ACCT.NO. <br /> FPC-or-E NO. <br /> LOCATION: <br /> NATURE OF WORK <br /> � <br /> FOREIGN STRUCTURES PRESS. CL. NEW SURFACE DISTURBED <br /> Tele O 1 O A TAP <br /> ❑ Road Mix Bituminous 0 Dirt <br /> Elec � 2 � C SIZE � Hot Mix Bituminous � Gravel <br /> � 5 � E ❑ Portland Cement Concrete � Oiled Earth <br /> Light/Traf.Cable � 6 ❑ F � Roadway � Blvd. � Walk � Alley <br /> Other O 8 � K <br /> Size Oisturbed <br /> PIPE LENGTH � Same Ft. Longer Ft.Shorter Ft.Abandoned <br /> SERVICE TAP MEASUREMENT <br /> DATESTARTED COMPLETED FOREMAN <br /> TRUCK NO. TOWN NO. FOREMANS P.R.NO. <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 GA COMPANY <br /> By � ` <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 /> of <br /> Date By <br /> (Authorized Signature) <br /> FORM 45A R3/78 <br />