Required fields are marked with asterisks (*)

Application and Payment for an Residential Access Permit

Farm, Single Family Detached and Semi-detached (Duplex)

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.

Access Permits are $100 ea., Visa and Mastercard accepted.

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

Purpose

Please check all that apply.

Proposed date of commencement of construction

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

Access Details

Plans must be submitted for approval.

Culvert required?

Yes

Width of entrance at property line (in metres)?

Width of entrance at road pavement (in metres)?

Posted speed limit (in km/h)?

Approximate grade of road (in %)?

Visibility: LEFT (Approximate metres, please be as specific as possible)

Visibility: RIGHT (Approximate metres, please be as specific as possible)

Region of Waterloo Form

Application and Payment for an Residential Access Permit

Farm, Single Family Detached and Semi-detached (Duplex)