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Rec'd in Street <br />Mpl».Q <br />Sub. <br />Map No. <br />CROHO <br />'i-n <br />MINNEGASCO <br />SERVICE INSTjMLATION <br />Customer ’s Name______ <br />Instollation Address___ <br />Legal Description: Lot <br />r i <br />.-W^No. <br />Contr’s Name___ <br />Contr’s Address <br />Owner ’s Nome <br />MUNICIPAL <br />PERMIT NO. ______ <br />ORDER NO. <br />E-NO. ■) <br />Class <br />Tel. <br />Tel. <br />Addition. <br />Tel., <br />Owner's Address______________ <br />Dote Ordered_2::^|.±lI2_ Max. Demand I CP/Hr. Taken By. <br />Main Aoth. No._________ _ __ <br />Add’l Info. ’>/ <u' ’ vrv i ' ,'nin ■■ i i-):5 , .0, <br />Service Locotion: Right 0 Left 0 Front 0 <br />Dote Completed .Foreman's Nome <br />To the (City Engineer A,X r AU <br />(City Council <br />(Village Council <br />(Town Board <br />The Minnesota Gas Company hereby requests permission to perform <br />the work indicated above. <br />MINNESOTA GAS COMPANY <br />(Chi«f Dttign Engin««r) <br />I <br />>:tt 4 <br />To the Minnesota Gas Company <br />Permission is hereby granted thejMinnesota Gas Company to perform <br />the work indicated above. I <br />.of <br />y <br />/ r * <br />(Authoriiwl SIgnolur*) <br />FORM 5»-3R 6/6S