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,._, MINNEGASCO SERVICE INSTALLATION
Map No. �`�' Natural Gas ❑ Propane Vapor ❑ Permit No.
Municipality �"�i'" Minneapol's Order No.
Folio No. Date Ordered ���3�� E No.
Customer's Name Tel.
Installation Address =`���� �'��t �1� k'��1 Zip
Lot Slock Addition
Method of Installation or Construc;ion (including method 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 M in Location
Additional Info. ��f'•P-' 'ri�: O� Sexvlee
Pre zure Class
Date Completed - '" Foreman's Name �'" �"�-��
To the (City Engineer
(City Council
(Village Council
�Town Board
The Minnesota Gas Company hereby requests permission to perform the work
indicated above.
MINNEGASCO, INC.
�jT��,.� �
(Sr. Design Engineer):/
To the Minnesota Gas Company
Permission is hereby granted the Minnesota Gas Company to perform the work
indicated above.
- }__
.-��. , '
_�� o f
Date _� `�`�%� By �
(Authorized Signaturel
Form 52 R 5/78