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MINNEGASCO, INC. 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 Nlix Bituminous � Dirt
Elec � 2 O C SIZE � Hot Mix Bituminous O Gravel
Q 5 � E � portland Cement Concrete � Oiled Earth
LighVTraf.Cable � 6 � F
� 8 O K � Roadway � Blvd. O Walk 0 Alley
Other Size Disturbed
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
(Viflage Council
(Town Board
The undersigned hereby requests permissioR to perform the work
indicated above.
MINNEGASCO, INC.
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(Sr. Design Engine�
To Minnegasco, Inc.
Permission is hereby granted Minnegasco, Inc. to perform the
work indicated above.
of
Date By
(Authorized Signature)
'M 45A R3/78