HomeMy WebLinkAbout1977-04-07 Notice of Gas Service RepairMINNESOTA GAS CO. MAINTENANCE ORDER NO.
❑ MAIN LZI SERVICE P.C. NO. NARUC OR E NO.
DATE _ MUNIC. RESP. ACCT. NO.
LOCATION:_
NATURE OF WORK
FOREIGN STRUC.
PRESS. CL.
SURFACE DISTURBED
PIPE LENGTH
TELE
❑❑ 1
❑ ASPHALT ❑ OIL
❑ SAME
ELEC
❑ 3
❑ CONCRETE ❑ DIRT
FT LONGER
❑ s
—
wU
❑ S
❑ ■LVO ❑ WALK ❑ ALLEY
FT SHCIVITER
OTHER
❑ e
SIZE DISTURBED
FT A1IANOONED
SERVICE TAP MEASUREMENT
I
DATE STARTED DATE COMPLETED FOREMAN
To the (City Engineer
(City Council
(Village Council
ITown Board
The undersigned hereby requests permission to perform the work
indicated above.
MINNESOTA GAS COMPANY
By
(Authorized Signature)
To the Minnewta Gas Company
Permission is hereby granted the Minnesota Gas Company to perform
the work indicated above.
of
Date By
(Authorized Signature)
Form 45A R 11/71