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Rec ’d in Street <br />r Mpis. <br />Sub. <br />MINNEGASCO <br />SERVICE INSTALLATION <br />Map Noj_ <br />elastomer ’s Name <br />pidU NewU Bldg. <br />MUNICIPAL <br />PERMIT NO. <br />ORDER NO. <br />E-NO. <br />Class <br />Tel. <br />Installation Address ■inz. <br />Legal Description: Lot No.Block No. <br />Addition_ <br />Contr's Name <br />rt' <br />Tel. <br />Contr’s Address <br />Ov/ner ’s Nome Tel. <br />Owner ’s Address <br />Date Ordered Max. Demand CF/Hr. Taken By <br />Main Auth. No. <br />Add’l Info. <br />Service Location: Right Q Left Q Front Q <br />Date Completed Foreman ’s Name <br />To the (City Engineer XX <br />(City Council <br />(Village Council <br />(Town Board <br />CAIX <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 the Minnesota Gas Company to perform <br />the work indicated above. <br />Date <br />(Authofixed Signoture) <br />FORM 5?-3R 6 69