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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas ❑ Propane Vapor ❑ Permit No. <br />Municipality Ornr►ri Minneapolis ❑ Order No. 3(in41 <br />Folio No. Date Ordered E No. '?il <br />1L1 <br />r's Nam C1P?-;11r i toft•iv Tel. <br />nstallation Address ~4a rlicknv IsakEa fir- Zip <br />Installation <br />Sock __1 Addition <br />Method of Installation or Construction (including method of compaction <br />and excavation) will be in accordance with procedures as described in <br />Minnegesco 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 Class <br />Deft Foreman's Name <br />To the (City Engineer <br />(City Council <br />(Villape Council <br />(Town Board <br />Minnegasco Inc. hereby requests permission to perform the work oK%CSted <br />above. <br />MINNEGASCO, INC. <br />(s i.or) <br />To MinneQ <br />i►ereby Minnegasco <br />s <br />K, y <br />Date ,,... By _ <br />Inc. to perform the work indicated <br />of <br />Form 52 R 5178 <br />(Authorized Sipeture) <br />