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Rec'd in Street <br />MpIs.Ql <br />Sub. <br />Map No^______ <br />MINNEGASCO <br />SERVICE INSTALLATION <br />Old <br />Customer's Name __________ <br />Installation Address_______ <br />Legal Description: Lot No. <br />NewQ Bldg. <br />MUNICIPAL <br />PERMIT NO. <br />ORDER NO. <br />E-NO. <br />Class <br />Tel. <br />Block No. <br />Addition_ <br />Contr's Nom“__ <br />Contr's Address <br />Owner's Nome <br />Tel. <br />Tel. <br />Owner ’s Address <br />Date Ordered ___ <br />Main Auth. No.__ <br />Add’l Info. <br />Max. Demand CF/Hr. Taken By <br />Service Location: Right ["3 Left Q Front <br />Date Completed Foreman ’s Name <br />To the (City Engineer <br />(City Council <br />(Village Council <br />(Town Board <br />The Minneapolis Gas Company hereby requests permission to perform <br />the work indicated above. <br />MINNEAPOLIS GAS COMPANY <br />7\1 <br />t- Q <br />(CKi«f Design Login er) <br />To the Minneapolis Gas Company <br />Permission is hereby granted the Minneapolis Gas Company to perform <br />the w k indicated above. <br />Date. <br />r- <br />(Authorit«d Signotur*) <br />rORM S2>3R e/»«