HomeMy WebLinkAboutemergency gas repair MINNEGASCO, INC. MAINTENANCE ORDER NO.
O MAIN 0 SERVICE PAV.CUT NO. LEAK RPT.NO.
DATE MUNIC. RESP.ACCT.NO.
FPC-or-ENO.
LOCATION:
NATURE OF WORK
FOREIGN STRUCTURES PRESS.CL. NEW SURFACE DISTURBED
Tele � � 0 '�' TAP 0 Road fNix Bituminous � Dirt
Elec � 2 � C $IZE O Hot Mix Bituminous O Gravel
� 5 � E � Portland Cement Concrete 0 Oiled Earth
Light/Traf.Cable � 6 � F � Roadway � Blvd. O Walk � Alley
Other � 8 � K
Size Disturbed
PIPE LENGTH 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.
MINNEGASCO, INC.
r (Sr. Design Engine�
To Minnegasco, Inc.
Permission is hereby granted Minnegasco, Inc. to perform the
work indicated above.
of
Date By
(Authorized Signature)
FORM 45A R3/78