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Rec' Street <br />MUNICIPAL <br />MINNEGASCO PERMIT NO. <br />MPIs.❑ SERVICE INSTALLATION ORDER NO. <br />Sub. _'. E-NO. i <br />Map No. ibb Old❑ New❑ Bldg. Class <br />Customer's Name. -,9; Tel. <br />Installation Address _ i045W—ter *p1? <br />Legal Description: Lot No. Block No. <br />Addition <br />Contr's Name <br />Contr's Address <br />Owner's Nome_ <br />Owner's Address <br />Tel. <br />Tel. <br />Date Ordered Max. Demand CF/Hr. Taken By <br />Main Auth. No. Service Location: Right ❑ Left ❑ Front ❑ <br />Add' I Info. <br />Date Completed Foreman's Name <br />To the (City Engineer XX <br />(City Council <br />(Village Council <br />(Town Board <br />The Minnesota Gas Company hereby requests permission to perform <br />the work indicated above. <br />MINNESOTA GAS COMPANY <br />(Chief Design Engineer) <br />To the Minnesota Gas Company <br />Permission is hereby granted the Minnesota Gas Company to perform <br />the work indicated above. <br />of <br />Date <br />(Authorized Signature) <br />FORM 52-3R 6 69 <br />