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MINNEGASCO, INC. MAINTENANCE ORDER NO. <br /> O MAIN 0 SERVICE PAV.CUT NO. LEAK RPT.NO. <br /> DATE MUNIC. RESP.ACCT.NO. <br /> FPC-or-ENO. <br /> LOCATION: <br /> NATURE OF WORK <br /> FOREIGN STRUCTURES PRESS.CL. NEW SURFACE DISTURBED <br /> Tele � � 0 '�' TAP 0 Road fNix Bituminous � Dirt <br /> Elec � 2 � C $IZE O Hot Mix Bituminous O Gravel <br /> � 5 � E � Portland Cement Concrete 0 Oiled Earth <br /> Light/Traf.Cable � 6 � F � Roadway � Blvd. O Walk � Alley <br /> Other � 8 � K <br /> Size Disturbed <br /> PIPE LENGTH O 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 /> MINNEGASCO, INC. <br /> r (Sr. Design Engine� <br /> To Minnegasco, Inc. <br /> Permission is hereby granted Minnegasco, Inc. to perform the <br /> work indicated above. <br /> of <br /> Date By <br /> (Authorized Signature) <br /> FORM 45A R3/78 <br />