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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas 0 Propane Vapor D Permit No <br />Municipality Q&-;J,j.A Minneapolis O Order No <br />Folio No. Date Ordered l�—�,T._ E No <br />II <br />ustomer's Name la���:�o 14 RQ,gQKs Tel. <br />stallation Address IZ4 Lh��rTLh�s Ua iV� Zip <br />ot 1_ Block Addition H i l lsTMaQor <br />Method of Installation or Construction (including method of compaction <br />and excavation) will be in accordance with procedures as described in <br />Minnegasco Operations Manual, Section 500, "Excavating, Backfilling and <br />Surfacing", the most recent edition on file with the permitting authority. <br />Install <br />Additional Info. <br />Service Main Location <br />Pressure Class <br />Date Uompleted Foreman's Name <br />To the (City Engineer <br />(City Council <br />(Village Council <br />(Town Board <br />The Minnesota Gas Company hereby requests permission to perform the work <br />indicated above. <br />MINNESOTA GAS COMPANY <br />(Chief Engineer) <br />To the Minnesota Gas Company <br />Permission is hereby granted the Minnesota Gas Company to perform the work <br />indicated above. <br />yl: of <br />Date By <br />(Auth6rized. Signature) <br />Form 52 R 5!78 <br />