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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas ❑ Propane Vapor ❑ Permit No <br />Municipality 0 'm 11 Minneapolis E:1 Order No. s r 1 <br />Folio No. Date Ordered E No. ip <br />Customer's Name de+... 1 ` ,rF+ `- - - Tel. <br />Installation Address 2� 1 ekelkee - Zip. <br />Los 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, Backtilling and <br />Surfacing", the most recent edition on file with the permitting authority. <br />Install: Service Main Location <br />Additional Info. <br />Pressure Class <br />Date Completed . Foreman's Name <br />To the (City Engineer <br />(City Council <br />(Village Council <br />(Town Board <br />The Minnesota Gas Company hereby requests permission to perform the work <br />indicated above. <br />MINNESOTA GAS COMPANY <br />To the Minnesota Gas Company <br />Permission is hereby granted the Minnesota Gas Company to perform the work <br />indicated above. <br />.f3.tt.. —of <br />Date /1 0/79 BY <br />(Authorized' ianaturoi <br />