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.�_�� ��.��q�m v,;�E�� � � , ,�. _ <br /> a ., � �,x .�� ..�_ �. <br /> MINNEGASCO, INC. MAINTENANCE ORDER NO. <br /> O MAIN O SERVICE PAV.CUT NO. LEAK RPT.NO. <br /> DATE MUNIC. RESP.ACCT.NO. <br /> FPC-or-E NO. <br /> LOCATION: <br /> NATURE OF WORK <br /> FOREIGN STRUCTURES PRESS.CL. NEW SURFACE DISTURBED <br /> Tele � 1 O A TAP <br /> 0 Road Mix Bituminous � Dirt <br /> Elec � 2 � C SIZE O Hot Mix Bituminous O Gravel <br /> � 5 � E O Portland Cement Concrete O Oiled Earth <br /> LighVTraf.Cable O 6 � F <br /> O 8 Q K O Roadway � Blvd. � Walk � Alley <br /> Other Size Disturbed <br /> PIPE LENGTH ❑ Same Ft. Longer Ft.Shorter Ft.Abandoned <br /> SERVICE TAP MEASUREMENT <br /> DATESTARTED COMPLETED FOREMAN <br /> TRUCK NO. TOWN NO. FOREMANS P.R.NO. <br /> To the (City Engineer <br /> (City Council <br /> (Village Council ,,� <br /> (Town Board k <br /> The undersigned hereby requests permission to perform the work <br /> indicated above. <br /> :,,::;- MINNEGASCO, INC. <br /> }+l � � s,��� , <br /> �y� <br /> (Sr. Design Engineer) <br /> To Minnegasco, Inc. ' <br /> Permission is hereby granted Minnegasco, Inc. to perform the <br /> work indicated above. <br /> of <br /> Date By <br /> (Authorized Signaturel <br /> FORM 45A R3/78 <br />