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M�NNEGASCO SERVICE INSTALLATION
Map No. Natural Gas � Propane Vapor ❑ Permit No.
Municipality Minrieapolis � Order No. _
Folio No. Date Ordered E No.
Customer's Name Tel.
Installation Address Zip
Lot Block Addition
�' Method of Installation or Construction (including method of compaction ��
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�'`` 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.
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Install: Service Main Location
Additional Info.
Pressu're Class
Date Completed Foreman's Name
To the (City Engineer
(City Council
(Village Council `�
(Town Board
Minnegasco Inc. hereby requests permission to perform the work indicated -
above.
MINNEGASCO, INC. -
,
�C�CG�T-�.G��--��'��"� .�.
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(Supervisor) �';��
;"r:�
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To Minnegasco, Inc.
Permission is hereby granted Minnegasco, Inc. to perform the work indicated
above. "c�.
of
Date By
(Authorized Signature)
Form 52 R 5/78