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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas L Propane Vapor 1:1 Permit No <br />Municipality 0 rr:nu Minneapolis Order No <br />Folio No. Date Ordered > 1 E No <br />Customer's Name Mrs. Morgan Tel. <br />Install tion Address 4265 Forest Lake Drive South Zip <br />Lot 'i Block 1 Addition Forest Arms Add <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 />Date Completed <br />Service Main Location <br />To the (City Engineer <br />(City Council <br />(Village Council <br />(Town Board <br />rureman s Name <br />The Minnesota Gas Company hereby r- <br />indicated above. <br />To the Minnesota Gas Company <br />Pressure Class <br />is permission to perform the work <br />MINNESOTA GAS COMPANY <br />i (Chief Engineer) <br />Permission is hereby granted the Minnesota Gas Company to perform the work <br />indicated above. <br />v <br />DatBy �!�,�4..J �.- C4_• C�V <br />(Authorikad Signature) <br />Form 52 R 5,178 <br />