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Recd in Street <br />MINN EGASCO <br />MPIs.❑ SERVICE INSTALLATION <br />Sub. <br />Map No. Old❑ New❑ Bldg. <br />Customer's Name <br />Installation Address <br />Legal Description: Lot No. Block No. <br />Addition_ <br />Contr's Name _ Tel. <br />Contr's Address <br />Owner's Name Tel. <br />Owner's Address <br />Date Ordered Max. Demand CF,/Hr. Taken By <br />Main Auth. No. Service Location: Right 0 Left ❑ Front ❑ <br />Add'I Info. <br />MUNICIPAL <br />PERMIT NO. <br />ORDER NO. <br />E -NO. <br />Class <br />Tel. <br />Date Completed <br />To the (City Engineer <br />(City Council <br />(Village Council <br />(Town Board <br />Foremon's Name <br />The Minneapolis Gas Company hereby requests permission to perform <br />the work indicated above. <br />MINNEAPOLIS GAS COMPANY <br />(Chief Design Engineer) <br />To the Waneapolis Gas Company <br />Permission is hereby granted the Minneapolis Gas Company to perform <br />the wcrk indicated above. <br />of <br />Date <br />(Authorised Signature) <br />FORM 52- R 05 69 <br />