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Map No, MINNEGASCO SERVICE INSTALLATION <br />Pid <br />Natural Gas '�) <br />��iC +„ pane Vapor ) Permit No I <br />Municipality Minneapolis I] Order No 281111 I <br />Folio No. Date Ordered 11-2-A4 E No ?0 <br />Customer's Name "bul- s M cr &,t)y Tel. <br />Installation Address I�.•'0 Brackett_ p ,irn��u, <br />Lot Block Addition Zip <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 />Surfacing".the most recent edition on file with the permitting authority. <br />Install: Service Main <br />Location <br />Additional Info. <br />Pressure Class <br />Date Completed Foreman's Name i <br />To the (City Engineer <br />(City Council <br />1 <br />1 .'-Ilage COLIMAl <br />(Town Board <br />I <br />Minnegasco Inc hereby requests permission to perform the work indicated <br />above. <br />rMINNEGASCO. INC. <br />jISr Des qn Engineer):.j <br />To Minnegasco. Inc. <br />above. Permission is hereby granted Minnegasco. Inc to perform the work indicated <br />r%I <br />Date By <br />(Author,ted Signature) <br />form 52 R 5.78 <br />