Fillable RESIDENTIAL CARE FACILITY (RCF) DISTANCE SEPARATION REQUEST (The City of Miramar)

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RESIDENTIAL CARE FACILITY (RCF) DISTANCE SEPARATION REQUEST (The City of Miramar)

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City of Miramar
Community & Economic Development Department
2200 Civic Center Place, Miramar FL 33025
RESIDENTIAL CARE FACILITY (RCF) DISTANCE SEPARATION REQUEST
Residential Care Facility is any facility classified by the State agencies licensing Community Residential Homes as Assisted
Living Facility (ALF) and Adult Family Care Home (AFCH) for the Agency for Health Care Administration (AHCA); and Group
Home (GH) for the Agency for Persons with Disabilities (APD). The application and appropriated licenses are processed and
provided by the State of Florida. The City of Miramar is only responsible for verifying that a proposed site is not within
1000/1200 feet from an operating facility pursuant to Florida Statute 419 and Miramar LDC 405.5.
Requirements to apply for approval of RCF distance separation request:
Proof of Ownership (Broward County Appraisal print out or copy of current Deed)
Show the completed State of Florida application from AHCA (ALF, AFCH) or APD (GH)
Application Date: Application Number:
Applicant Name:
Facility Name:
Applicant Address:
Applicant Phone:
Applicant Email:
Proposed location address:
Proposed location zip code:
Proposed location Parcel ID
Number of Residents: License Type: ALF AFCH GH
Agency for Health Care Administration (AHCA) Agency for People with Disabilities (APD)
*ALF - Assisted Living Facility AFCH: Adult Family Care Home *GH - Group Home
Capacity
Distance (Feet)
Residential Zoning District
Fee
Up to 6
1,000
Single Family
$162.00
7 to 14*
1,200
Multi-Family
$216.00
*Requires a zoning confirmation letter. The approval for the distance separation is valid for six months. Extension
(up to 2) will cost $162.00 each.
Important Links:
Interactive Map for proposed location distance verification (Miramar Maps - GIS)
Agency Health Care Administration (AHCA)
Assisted Living Facility (ALF)
Adult Family Care Home (AFCH)
Licensed Adult Family Care Homes and Assisted Living Facilities can be searched at:
http://www.floridahealthfinder.gov/facilitylocator/facloc.aspx
Agency for Persons with Disabilities (APD) Group Home (GH)
Licensed Group Homes can be searched at:
http://www.flddresources.org/ProviderSearch.aspx
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RESIDENTIAL CARE FACILITY (RCF) DISTANCE SEPARATION REQUEST (The City of Miramar)

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Completed 19 January 2021

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