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R,�c'd in Street <br />MINNEGASCO <br />NIP 15.1- SERVICE INSTALLATION <br />Sub. <br />Map No. <br />Customer's <br />Installation Address <br />Legal Description: Lot No. <br />Old, i NewC Bldg. <br />Block No. <br />MUNICIPAL <br />PERMIT NO. <br />ORDER NC. <br />E -NO. _ <br />Class <br />Tel. <br />Addition <br />Contr's Name _ _ Tel. <br />Cont►'s Address <br />Owner's Name _ Tel. <br />Owner's Address <br />Date Ordered �i,'2�/lr Max. Demand CF Hr. Taken By <br />Main Auth. No. Service Location: Right ❑ Left [] Front <br />Add'I Info. ,/8" FE sorv;cc ai; 1"-.6, CiLt•te i <br />i ut t Lu_r t <br />Date Completed Foreman's Name <br />To the (City Engineer L`XX C/ ` <br />(City Council <br />(Village Council <br />(Town Board <br />The Minneapolis Gas Company hereby requests permission to perform <br />the work indicated above. <br />MINNEAPOLIS GAS COMPANY <br />C' I <br />VL <br />(Chief Design Engineer) <br />To the Minneapolis Gas Company <br />Permission is hereby granted the Minneapolis Gas Company 'o perform <br />the work ;ndicated above. <br />of <br />Date By _ <br />(Authorized Signature) <br />FORM 7:•3R 01 69 <br />