HomeMy WebLinkAbout1981-09-09 Notice of Gas Service Repairrw^m-
MINNESOTA GAS CO. MAINTENANCE
O MAIN 1^ SERVICE PAV. CUT NO.
DATE 9-9-31 MUNic. Or#no
ORDER NO.
LEAK RPT, NO.
RESP. ACCT. NO.
FPC -or -E NO.
7117
39/
LOCATION 286^5 Casco Politt
NATURE OF WORK Reo« Ir Sc^rv Ic ?
FOREIGN STRUCTURES
T«l«
El«c
Liyht/Traf. Cabla
Oihar
PRESS. CL.
□ 1 □ A ‘
□ 2 □ C
n 5 a E
a 6 a F
□ 8 a K
H
NEW
TAP
SIZE
SURFACE DISTURBED
O Road Mix Bituminous O Dirt
O Hot Mix Bituminous O Gravel
CJ Portland Cement Concrete D Oiled Earth
O Roadway O BUd. Cj Walk Cl Alley
Size Disturbed
PIPE LENGTH O Same Ft. Longer Ft. Shorter Ft. Abandoned
SERVICE TAP MEASUREMENT
DATE STARTED
TRUCK NO. ___
«»Sv COMPLETED 3- /-31 FOREMAN__
— TOWN NO-------------------------FOFiLMANSP.R. NO.
Sza£larstcl
To th« (City Enginoor
(City Council
(Village Council i '
(Town Board %
The undersigned hereby requests permission to perform the work
indicated above.
MINNESOTA GA^OMPANY
/J (Authorired Signature)
To the Minnesota Gas Company
Parminion it hereby grented the Minnesota Get Company to perform
tha ysork indicated ebove.r
... rrf',
f - /-< 9/
[Authori/ecJ Signature 1
FORM 4SA R3/78
iiia