HomeMy WebLinkAbout12-18-1979 Notice of Gas Service RepairMINNESOTA GAS CO. MAINTENANCE
❑ MAIN 0 SERVICE PAV. CUT NO.
` DATE 1 _( R_ 7q MUNIC. n r n n n RESP. ACCT. NO.
G FPC • or . E NO.
ORDER NO. R 7n 3
LEAK RPT. NO.
R1
LOCATION: l h -O R R a l d u r P n r k R a d
� NATURE OF WORK r it l. t M 1 n
FOREIGN STRUCTURES
Tele
I Elec
E Light/Traf. Cable
f Other
PRESS. CL.
NEW
❑ t
❑
A
TAP
❑ 2
❑
C
SIZE
❑5
❑
E
❑ G
❑
F
0
❑
K
SURFACE DISTURBED
❑ Road Mix Bituminous
❑ Hot Mix Bituminous
❑ Portland Cement Concrete
❑ Dirt
❑ Gravel
❑ oiled Earth
❑ Roadway ❑ Blvd. ❑ Walk ❑ Alley
Size Disturbed
PIPE LENGTH CO Same Ft. Longer Ft. Shorter Ft. Abandoned
SERVICE TAP MEASUREMENT
DATE STARTED COMPLETED�+ ., �FOREMAN, P,"�„1
TOWN NO. FOREMANS P.R. NO
To the (City Engineer
(City Council
(Village Council
(Town Board
The undersigned hereby requests permission to perform the work
indicated above.
MINNESOTA GA COMPANY
By '
/J: (Authorized Signature)
To the Minnesota Gai Company
Permission is hereby granted the Minnesota Gas Company to perform
the work indicated above.
t of
Date . , -. -� — "I By
(Authorized Signature) !
FORM 45A R3/78