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� „;,. �, v�• - _�,.� ,; 3. ;:.'a, ,,: <br /> MINNEGASCO, INC. 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 /> FOREIGN STRUCTURES PRESS.CL. NEW SURFACE DISTURBED <br /> Tele � � � A TAP O Road Mix Bituminous � Dirt <br /> Elec � z � C SIZE O Hot Mix Bituminous � Gravel <br /> � 5 O E O Portland Cement Concrete O Oiled Earth <br /> LighVTraf.Cable � 6 � F 0 Roadway 0 Blvd. � Walk � Alley <br /> Other � 8 � K <br /> Size Disturbed <br /> PI?E 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 /> MINNEGASCO, INC. <br /> n. � f s .i^ �73 �'! 1v��/�R�� <br /> i' <br /> (Sr. Design Engineer) <br /> To Minnegasco, Inc. <br /> '� Permission is hereby granted Minnegasco, Inc. to perform the <br /> d <br /> } work indicated above. <br /> r�: <br /> '' of <br /> ; <br /> � <br /> Date By <br /> �; (Authorized Signature) <br /> FORM 45A R3/78 <br />