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MINNEGASCO SERVICE INSTALLATION <br />Map No. Natural Gas Cl Propane Vapor (.] Permit No. <br />Municipality nrnnn Minneapolis O Order No. = i <br />Folio No. Date Ordered 1n-2—�o E No. it, <br />Customer's Name Cary Pr int .rP Tel. <br />Installation Address 171;1 Br' 1;ir t 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 5DO, "Excavating, Backfilling and <br />Surfacing", the most recent edition o -i file with the permitting authority. <br />Install <br />Additional Info <br />Service Main Location <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 perforin the work <br />indicated above. <br />r,iINNESOTA G4S COMPANY <br />t <br />(Chief Engineer) <br />To the Minnesota Gas Company <br />Permission is hereby granted the Mtnnesuta Gas Company to perform the work <br />indicated above. <br />of <br />Date By <br />IAuthonted Signature) <br />