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Get FL AHCA Local Zoning Form 2010-2024

TO The Agency for Health Care Administration Hospital and Outpatient Services Unit 2727 Mahan Drive MS 31 Tallahassee FL 32308 Regarding Facility Name Street Address City State Zip Applicant s Name owner The local zoning ordinances for the above street address have been reviewed. It has been determined that the street address listed above does does not permit the operation of a Level I or Level II Residential Treatment Facility RTF. Local Zoning Form Date This form is to be completed by the local zoning office and not by the facility applicant. Signature of Zoning Official Printed Name of Official Title Zoning Agency Name City State Zip Code If available please staple a business card to this form as verification the form was completed by the zoning authority. AHCA Recommended Form Feb 2010 Page 1 of 1 Available at http //ahca*myflorida*com/MCHQ/HealthFacilityRegulation/HospitalOutpatient/residential*shtml. Signature of Zoning Official Printed Name of Official Title Zoning Agency Name City State Zip Code If available please staple a business card to this form as verification the form was completed by the zoning authority. AHCA Recommended Form Feb 2010 Page 1 of 1 Available at http //ahca*myflorida*com/MCHQ/HealthFacilityRegulation/HospitalOutpatient/residential*shtml. .

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