HomeMy WebLinkAbout1979-12-18 Notice of Gas Service Repairrr Z0 ^ * WT-’rrr—p*..ir--'^<n<.Tw^ rf7:WTw. »-T-»-*K«v^ '
MINNESOTA GAS CO. MAINTENANCE
a MAIN (59 SERVICE PAV. CUT NO.
DATE 1 7- 1 a- ?q MUNIC. Qronn
ORDER NO.
LEAK RPT. NO.
RESP. ACCT NO.
FPC • Of - E NO.
8706
LOCATION !lSX W '^01^ C n f o Point Ho ij d
892
NATURE OF WORK R p> p a t r S r v I r
FOREIGN STRUCTURES PRESS. CL.NEW
T«i«CD 1 n A TAP
Elec CD 2 CD c
r~l f% n c
SIZE
3 1__1 k-
LIght/Traf. Cable a 6 □ F
Other
a 8 a K
SURFACE DISTURBED
O Road Mix Bitummout
O Hot Mix Bituminous
[□ Portland Cement Concrete
□ Dirt
O Gravel
CD Oiled Earth
CD Roadway CD Blvd CD Walk CD Alley
Si/e Disturbed
PIPE LENGTH CD Same Ft. Longer Ft Shorter Ft. Abandoned
SERVICE TAP MEASUREMENT
DATE STARTED
TRUCK NO. ___
COMPLETED | p _ ^ ^ ^ p FOREMAN
TOWN NO______________FOREMANS P.R. NO. _________
i-Uii
Toth* (City Engin««r
(City Council
(Village Council
(Town Board
■
■
The ursdert^ed hereby requests permission to perform the work
indiceled above.
MINNESOTA GA$COMPANY
/J (Authofi/ed Signature)
To the Minrseeote Get Company i
Parmtwion ia h*r*tiy granted th* Minnetota Ga* (^mpany to perform
the work irnliceted above.i
0... 7T 1*1 . . .. .1 .L
(Authorised Signature)
■4
FORM 4iA R3/7i