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MINNEGASCO SERVICE INSTALLATION <br />Map No. i 6t, Natural Gas =l Propane Vapor U Permit No <br />Municipality r+= r Minneapolis Cl Order No <br />Folio No. Date Ordered ' ^ 1 r . ( E No <br />[ILI <br />ustomer's Name Henry Ska rp Tel. <br />stallation Address 104 Ferndale Boars vac:St Zip <br />ot i Block Addition _- No i" t h 5hu r e Co t L ak,e <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 <br />Pressure Class <br />Date Completed _ Foreman's Name <br />To the (City Engineer <br />(City Council <br />(Village Council <br />(Town Board <br />8444 <br />7446 <br />Loc.,ition <br />The Minnesota Gas Company hereby requests permission to perform the work <br />indicated above. <br />MINNESOTA GAS COMPANY <br />7 (Chief Engineer) <br />To the Minnesota Gas Cornpany <br />Permission is hereby granted the Minnesota Gas Company to perform the work <br />Indicated above. <br />T -of <br />By r <br />(Authorised Signature) <br />Form 52 R 5� 78 <br />