HomeMy Public PortalAbout1995-048314
miijilegasC®
A Division of Arkla, Inc.
City of
MGC # 1979
A2364-95
MEDINA
Permit no.
APPLICATION FOR PERMIT TO
INSTALL UTILITIES OR TO PLACE
UNDERGROUND CONSTRUCTION
Name of party or organization performing work MINNEGASCO, INC.
Address P.O. Box 1165, Mpls., MN 55440-1165 Telephone Richard J. Pilon, PE 321-5426
1. Nature of work ggas main installation
Type of surface to be disturbed AS REQUIRED
(Check type) ❑ Gravel
❑ gas service installation ❑ other
❑ Bituminous
❑ Concrete ❑ Boulevard
2. Location SEE ATTACHED DRAWINGS — TH 55, MOHAWK DR
Street, avenue and house number
(Additional information attached when necessary)
3. Size and kind of pipe, conduit or cable 3552' 4" AND 1353' 2" TR, CL 6
Depth from surface ❑ 2.5 feet f 43 feet ±
Dimensions of excavation AS REQUIRED
4. Method of installation or construction (including method of compaction and excavation)
In accordance with procedures described in Minnegasco Operations Manual: Procedures,
Section 500, "Installation': the most, recent edition on file with the permitting authority.
Machine excavation: Yes X No
5. Work to start within 30 days and be completed within 30 days thereafter.
6. Will detouring of traffic be necessary? NO If so, describe routing:
For MINNEGASCO, IN
Signed b
Date
0595
The date when work is completed must be reported to the person designated by municipality.
AUTHORIZATION OF PERMIT
Upon payment of permit fee in the amount of $ and in consideration of the agreement to comply in all
respects with the street or alley excavation ordinances and regulations applicable covering such operations, permission
is hereby granted for the work to be done as described in the above application, said work to be done in accordance with
special precautions required, as hereby stated:
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It is expressly understood that this permit is conditioned upon replacement or restoration of the road surface to its
proper condition in accordance with the appropriate rules and regulations. It is further understood that this permit is
subject to revocation within ten (10) days of receipt of copy of application by the county engineer when the permit is for
work on a county road.
APPROVED
DATE
All requirements shown on reverse side to be complied with.
White copy —applicant, Yellow —Municipality Engineer. Blue —Municipality Street Superintendent Form 16 R7/88
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