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MINNEGASCO SERVICE INSTALLATION <br /> Map No. Natural Gas ❑ Propane Vapor ❑ Permit No. <br /> Municipality Minneapolis � Order No. <br /> Folio No. Date Ordered E No. <br /> Customer's Name Tel. <br /> Installation Address Zip <br /> Lot 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, Backfilling and <br /> Surfacing",the most recent edition on file with the permitting authority. <br /> y ; <br /> �.:. <br /> .�$- <br /> Install: Service Main Location <br /> Additional I nfo. <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 /> MINNEGASCO, INC. <br /> /`/�T;�<c'�',�....��' �� <br /> (Sr. Design Engineer):/� � � � <br /> � <br /> To the Minnesota Gas Company <br /> Permission is hereby granted the Minnesota Gas Company to perform the work <br /> indicated above. <br /> • of <br /> Date By <br /> (Authorized Signature) <br /> Form 52 R 5/78 <br />