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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas Propane Vapor O Permit No. <br />Municipality Orpoo Minneapolis D Order No.5 <br />Folio No. Date Ordered in -2-7q E No. <br />IL <br />stomer's Name A 1 ti�. e r L-. .. ro i Q, Tel. <br />nstallation Address 13Cti _C.�� i ua Zip <br />ot I R Mock ___L_ Addition --JU I .l��M3nar <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 Completed 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 />(ZnEe 8y y= - l� -✓ <br />(Aut rizgd Signature) <br />Form 52 R 5/78 <br />