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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas ❑ Propane Vapor ❑ Permit No. <br />Municipality n r- Minneapolis ❑ Order No. 60 �4 <br />Folio No. Date Ordered I Q-2—�T E No. 3Q <br />lLot <br />ustomer's Name - t . -1- 1... 4Qa i r Tel. <br />nstallation Address j;9 Chevy Chane pr. Zip <br />2n Block I_ Addition W i I I coway <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 />L/dlC liU111EJIClCU FUf Clfldll 3 INOIIIc <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 />i Ikv of <br />Date i i .,i—'i B;;. <br />(Authorized Signature) <br />Form 52 H 5/78 <br />