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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 � 1 O A TAP
0 Road Mix Bituminous � Dirt
Elec � 2 � C SIZE O Hot Mix Bituminous O Gravel
� 5 � E O Portland Cement Concrete O Oiled Earth
LighVTraf.Cable O 6 � F
O 8 Q K O Roadway � Blvd. � Walk � 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
(Village Council ,,�
(Town Board k
The undersigned hereby requests permission to perform the work
indicated above.
:,,::;- MINNEGASCO, INC.
}+l � � s,��� ,
�y�
(Sr. Design Engineer)
To Minnegasco, Inc. '
Permission is hereby granted Minnegasco, Inc. to perform the
work indicated above.
of
Date By
(Authorized Signaturel
FORM 45A R3/78