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MINNESOTA GAS CO.MAINTENANCE ORDER NO. '+
O MAIN O SERVICE PAV.CUT NO. LEAK RPT.NO.
DATE MUNIC. RESP.ACCT.NO.
FPC-or-E NO.
LOCATION:
NATURE OF WORK
FOREIGN STRUCTURES PRESS.CL. NEW SURFACE DISTURBED
Tele � � � A TAP � Road Mix Bituminous O Dirt
Elec � 2 � C SIZE � Hot Mfx Bituminous � Gravel
� 5 � E � portland Cement Concrete � Oiled Earth
Light/Traf.Cable � 6 � F
� 8 � K � Roadway � Blvd. � Walk � Alley
Other Size Disturbed �
PiPE LE_NGTH O Same Ft. Longer Ft.Shorter Ft. Abandoned
SERVICE TAP MEASUREMENT
DATESTARTED COMPLETED FOREMAN
TRUCK.NO. TOWN NO. FOREMANS P.R.NO.
To the (City Engineer
(City Council
(Village Council
(Town Board
The undersigned hereby requests permission to perform the work
indicated above.
MINNESOTA GAS COMPANY
BY � , `
(Authorized Signature)
To the Minnesota Gas Company
Permission is hereby granted the Minnesota Gas Company to perform
the work indicated above.
of
Date By
i
(Authorized Signature)
FORM 45A R3/78