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MINNEGASCO SERVICE INSTALLATION <br />Map No. blU Natural Gas ❑ Propane Vapor ❑ Permit No. <br />Municipality Minneapolis ❑ Order No. 2957 1 <br />Folio No. Date Ordered %-H5 E No. 30 <br />1Qntomer's Name Gary Rc)dPr i Tel. <br />Installation Address 136 n i c!yi g-tke t� • Zip <br />Lot u Block �_ Addition <br />Method of Installation or Construction (including method of curnpaction <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: Service Main Location <br />Additional Info. <br />Pressure Clw. <br />Date Completed Foreman's Name <br />To the (City Engineer <br />(City Council <br />(Village Council <br />(Town Board <br />above. <br />Minnegasco Inc. hereby requests permission to perform tt�e work indicated <br />MINNEGASCO, INC. <br />6?4 . <br />To Minnegasco, Inc. = • ; it <br />Permission is l i&y grinted Minnegasco. Inc. to perform the work indicated <br />above. <br />of <br />Date By <br />(Authorized Signature) <br />Form 52 R 5/78 <br />