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Recd in Street <br />Mpls.❑ <br />Sub. ORONO <br />MINN EGASCO <br />SERVICE INSTALLATION <br />MUNICIPAL <br />PERMIT NO. <br />ORDER NO. <br />E -NO. <br />Map No. Old❑ New❑ Bldg. Class <br />Customer's Name _ r_.ic �r`n Tel. <br />Installation Address <br />Legal Description: Lot No. .,t !%14Block No. <br />Addition. <br />Contr's Name Tel. <br />Contr's Address <br />Owner's Name _ Tel. <br />Owner's Address <br />Date Ordered Max. Demand CF/Hr. Taken By <br />Main Auth. No. Service Location: Right ❑ Left ❑ Front ❑ <br />Add' I Info. <br />Date Completed <br />To the (City Engineer <br />(City Council <br />(Village Council <br />(Town Board <br />Foreman's Name <br />The Minnesota Gas Company hereby requests permission to perform <br />the work indicated above. <br />To the Minnesota Gas Company <br />MINNESOTA GAS COMPANY <br />(Chief Design Engineer) <br />Permission is hereby granted the Minnesota Gas Company to perform <br />the work indicated above. <br />of <br />Date — __---- _- By <br />(Authorized Signoture) <br />FORM 52-3R 6 059 <br />