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MINNEGASCO SERVICE INSTALLATION
Map No. Natural Gas ❑ Propane Vapor ❑ Permit No,
Municipality Minneapol;s ❑ Order No.
Folio No. Date Ordered _rS.} E No,
IL
stomer's Name �3 i�..�_..Abwkkad Tel.
nstallation Address j.Tr_F9;�eet Zip
ot Block Addition
Method of Installation or Construction (including methnd of compaction
and excavation) will be in accordance with procedures as described in
Minnegasco Operations Manual, Section 500, "Excavating, Backfilling and
Surfacing", the most recent edition on file with the permitting authority.
Install: Service Main _ Location
Additional Info.
Pressure Class
L/dle %,U111PICCCU rureman 5 Name
To the (City Engineer
(City Council
(Village Council
(Town Board
The Minnesota Gas Company hereby requests permission to perform the work
indicated above.
MINNESOTA GAS COMPANY
(Chief Engineer)
To the Minnesota Gas Company
Permission is hereby granted the Minnesota Gas Company to perform the work
indicated above.
of
QDate _ By --
(Auth izei Signature)
i
Form 52 R 5 78