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Recd in Street <br />MUNICIPAL <br />MINNEGASCO PERMIT NO. <br />Mpls.[1 SERVICE INSTALLATION ORDER NO. _JSP <br />Sub. E -NO. <br />Map No. Old❑ New❑ Bldg. Class <br />Customer's Name rtw Qpydur. Tel. <br />Installation Address 44 4oyv' <br />Legal Description: Lot No. Block No. <br />Addition <br />Contr's <br />Name <br />Contr's <br />Address <br />Owner's <br />Owner's <br />Address <br />Date Ordered <br />Main Auth. No. <br />Add' I Info. <br />Date Completed <br />Tel. <br />Tel. <br />Max. Demand ___ CF%Hr. Taken By <br />Service Location: Right 0 Left <br />Foreman's Name <br />Front ❑ <br />To the (City Engineer ,XX <br />(City Council A <br />LL <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 />(Chief Design Engineer) <br />To the Minnesota Gas Company <br />Permission is hereby granted ohe Minnesota Gas Company to perform <br />the work indicated above. <br />A. <br />FORM 52-3R 6 69 <br />LIZ <br />(Authorized S 3nature) <br />