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il <br />� � <br /> { <br /> APPLICATION FOR PIPE LINE PERMIT � <br /> � euauN�roN <br /> NORfHERN __. <br /> To BURLINGTON NORTHERN INC. � �, /�,{'� � <br /> Da[e <br /> 1. At what City or Village is permit desired7 E�E�E� � <br /> 2. Full name and address of Applicant C��% �'F�vc,y��f-_ Jxi��Tcin<� ����,qtisr <br /> . �?�t>n <'E;JiJfC _f'.—,�{ Ei-E/lrTT tv,q . <br /> 3. If Applicant is a corporation, in what state incorpora[ed7 w�'�S'"'�^����^� <br /> If an individual, under what firm name is busineu conducted7 <br /> If partnership, give name of all partners <br /> 4. Product to be handled in pipe line �EU/cQ <br /> 5. Pipe Da[a: CARRIER PIPE CASING PIPE <br /> a. OU[sidediame[er_T� j�'� CARRIERPIPE CASINGPIPE <br /> „ f. Actualworkingpressure � �J <br /> b. Inside diameter G /7'$'�' <br /> —r_ g. Type of joint ��6�:t' c.vSor'% lfitYU <br /> c. Pipematerial ��'��'= !�'k S'%cFa h. Coating_ �Y il�cr.c �iii E" <br /> N T <br /> d. Specifications i. Method of installation �°i%�'N�'t'6 <br /> and grade � j. Will cathodic protection <br /> e. Wall thickness ' `r�� ��� be provided? ��` /1i i— <br /> � �. <br /> G. a. Depth of pipe under track (top of tie to 6o:tum of casing) T C <br /> b. Angle of crossing �C�° —� <br /> 7. If pipe is to 6e placed longitudinally with track, give <br /> a. location of pipe in relation to centerline of nearest track -���— <br /> b. depth of coverage (ground line to top of pipe�— <br /> 8. if installation is to be by jacking or boring method give location of jacking and receivin;oits <br /> a. Dep[h <br /> b. Distance facing wall of pit to centerline of nearest track (measured normal) i-" <br /> 9. Reference plans(to be forwarded wi[h original application) <br /> a. Drawing Number 6.Prepared by <br /> Applicant agrees [hat i/ installation requires any or all of the following work; removal and replacement of track, bridging, <br /> protection of track ar other railway )acilities by�wrk or 1/agging,engineering and/o�supervision;such ivo�k is to be performed <br /> by rvrlway employes and [he cost bome by Applicant. lf in the opinion o/ the Railway Company sut/icient hazard is involved <br /> the Applirant will be required to tumish liability and properry damage insurance in form and amounts satisfactory to <br /> Budington Northem. � <br /> ey � ' <br /> (A�pli n (T' o) �i�/ <br /> RECOMMENDATIONS: (If additional space is required attach wpplemental sheeU <br /> Date _ 19 j <br /> APPLICATION APPROVED: _..� <br /> (Superintendentl <br /> (Attt.Vica President—Opomticns) � <br /> IGenorol Mannger Lousas) (Rogionol Mananer En ineerin �� <br /> FOflM 1G002 1.73 0 9) � � <br /> Printalin U.S.A, ' <br /> i <br /> i <br />