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Map No. <br />MINNEGASCO SERMCE INSTALLATION <br />___ Natural Gas □ Propane Vapor □ Permit No. <br />Municipality <br />Folio No ___ <br />nwriNj __ Minneapolis CD Order No ___ <br />Date Ordered E No. <br />Customer's Name <br />Installation Address <br />Lot Block _ <br />Tel. <br />Zip. <br />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", most recent edition on file with the permiuing 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 />QrU/I <br />V> ^ <br />/ <br />/ /(Chief Engineer) <br />To the Minnesota Gas Company <br />Permission is hereby granted the Minnesota Gas Company to perform the work <br />irHiicated above. <br />. nl / C <br />n,.. /.^ - / 5 7/By .1 -- - - - <br /><Authoft/«d S«9n«ture)