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Map No. <br />MINNEGASCO SERVICE INSTALLATION <br />■ Natural Gas □ Propane Vapor CD Permit No. <br />Municipality Q r nna <br />Folio No ________ <br />Minneapolis □Order No. <br />Date Ordered E No. fUhfi <br />______________________________Tel. ______ <br />Installation Address ^21*^ Cascn Circle ____ Zip ___ <br />Customer's Name <br />Installation Addrt <br />Lot -J3_ Block <br />J - P I <br />Addition Spring Park <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", the most recent edition on file with the permitting authority. <br />Install:_______ <br />Additional Info. <br />Service Main <br />Pressure Class <br />Date Completed Foreman's Name <br />Location <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 />/r f (Chief Engineer) <br />V t A- <br />To the Minnesota Gas Company <br />Permission is hereby granted the Minnesota Gas Company to perform the work <br />indicated above. <br />/J? ^ <br />- T ^ <br />Rw '*' ■ \ ^ - . ■ J > ( , j <br />r (AuthorI/ed Signature) <br />form 52 R 5/7fi