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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 O 1 O A TAP
❑ Road Mix Bituminous 0 Dirt
Elec � 2 � C SIZE � Hot Mix Bituminous � Gravel
� 5 � E ❑ Portland Cement Concrete � Oiled Earth
Light/Traf.Cable � 6 ❑ F � Roadway � Blvd. � Walk � Alley
Other O 8 � K
Size Oisturbed
PIPE LENGTH � 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 GA 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
(Authorized Signature)
FORM 45A R3/78