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MINNEGASCO SERVICE INSTALLATION <br /> Map No. Natural Gas ❑ Propane Vapor � Permit No. <br /> Municipality Minneapolis � Order No. <br /> Folio No. Date Ordered �"�`�' E No. <br /> Customer's Name Tel. <br /> Installation Address Zip <br /> Lot Block�. Addition <br /> Method of Installation or Construction (including method of compaction <br /> and excavation) will be in accordance with procedures as described in <br /> Minnegasco Operations Manual,Section 500, "Excavating, Backfilling and <br /> Surfacing",the most recent edition on file with the permitting authority. <br />� <br /> S <br /> Install: Service Main Location <br /> Additional Info. <br /> Pressure Class <br /> Date Com leted Foreman's Name <br /> To the (City Engineer <br /> (City Council <br /> (Village Council <br /> (Town Board <br /> Minnegasco Inc. hereby requests permission to perform the work indicated <br /> above. <br /> MINNEGASCO, INC. <br /> � <br /> � C�IG�y��--�z'/l'/� <br /> (Supervisor) <br /> To Minnegasco, Inc. <br /> Permis�ion is hereby granted Minnegasco, Inc. to perform the work indicated <br /> above. , <br /> � y�t, <br /> �}�?' ' <br /> /��— <br /> of <br /> . .�. ,. <br /> Date � . By <br /> (Authorized Signature) <br /> Form 52 R 5/78 <br />