Region of Waterloo Form

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Required fields are marked with asterisks (*)

Application for an Access Closure

Note: Access to a Regional Road must comply with the provisions of the Region of Waterloo Controlled Access By-law #58-87 and the Policy and Procedures for Access onto a Regional Road, as ameded from time to time.

Owner Contact Information

Owner First Name:

Owner Last Name:

Company

Owner Address: (Street, Apt. No., P.O. Box, R.R. No.)

City/Town:

Province:

Postal Code

Phone Number:

Email:

Is the Applicant different from the Owner information provided?

Yes

Location of Access

Where there is no address, describe location by adjacent physical features, like north, south, etc.

On Regional Road No./Name:

Side of Road (North, South, East, West):

Full Address or Location of Entrance:

City/Town:

Province:

Postal Code

Proposed date of commencement of closure:

Land Use - Please provide a detailed description of the type of property/development:

Width of entrance at property line (in metres)?

Width of entrance at road pavement (in metres)?