HomeMy WebLinkAbout1979-12-18 Notice of Gas Service RepairMINNESOTA GAS CO. MAINTENANCE ORDER NO. ' ; 0
❑ MAIN W SERVICE PAV. CUT NO. LEAK RPT. NO.
DATE 1 2- 1 e- 7 q MUNIC. 0 r O f1 0 RESP. ACCT. NO.
FPC - or -E NO. r Q!
LOCATION: 3505 Crystal P lace
NATURE OF WORK R e Q a i r -St., V i C P
FOREIGN STRUCTURES
PRESS. CL.
NEW
SURFACE DISTURBED
Tel@
Q t Q A
TAP
❑ Road Mix Bituminous ❑ Dirt
Elec
0 2 Q C i
SIZE
0 Hot Mix Bituminous ❑ Gravel
Q 5 Q . i
El Portland Cement Concrete O Oiled Earth
Light/Tref. Cable
Q 6 C.]
❑ Roadway ❑ Blvd. 0Walk Q Alley
Q 8 Q
LI
Size Disturbed
Other
PIPE LENGTH ❑ Some Ft. Longer Ft. Shorter Ft. Abandoned
SERVICE TAP MEASUREMENT
' DATE STARTED COMPLETED FOREMAN
L TRUCK NO. TOWN NO.
To the (City Engineer
(City Council
(Village Council
(Town Board
FOREMANS P.R. NO.
The undersigned hereby requests permission to perform the work
indicated above.
MINNESOTA GA ANY
BY
/ (Authorized Signature)
To the Minnesota Gas Company
Permission is hereby granted the Minnesota Gas Company to perform
the work indicated above.
C + A u of fJ L-)
Date �' `• t 1( By
(Authorized Signature
FORM 45A R3/78