Fillable Sussex County, Delaware Ap plication for Group Residential (Sussex County Council)

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Sussex County, Delaware Ap plication for Group Residential (Sussex County Council)

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Case #___________
Sussex County, Delaware
Sussex County Planning & Zoning Department
2 The Circle (P.O. Box 417) Georgetown, DE 19947
(302)
855-787
8 ph. (302) 854-5079 fax
Ap
plication for Group Residential Facility for Persons with Disabilities
Purpose: A group residential facility licensed and approved by the appropriate state agencies serving 10 or fewer
persons with disabilities on a twenty-four-hour-per-day basis (a “Group Residential Facility for Persons with
Disabilities”) is considered a single family dwelling under the Sussex County Code, Chapter 115 (Zoning), § 115-4(B).
The purpose of this Application is to provide the Applicant with an opportunity to demonstrate that its proposed use
of the property as set forth in this Application meets the definition of a Group Residential Facility for Persons with
Disabilities under the Sussex County Code.
Property Address: ______________________________________________________________
Tax Map #: ____________________________________ Property Zoning: _______________
Applicant Information
Applicant Name: ________________________________________________________________
Applicant Address: ______________________________________________________________
City, State, Zip: _________________________________________________________________
Applicant Phone #: __________________ Applicant e-mail: ____________________________
Property Owner Information
Owner Name: __________________________________________________________________
Owner Address: ________________________________________________________________
City, State, Zip: ________________________________________ Purchase Date: ____________
Owner Phone #: __________________ Owner e-mail: _________________________________
Agent/Attorney Information
Agent/Attorney Name: ___________________________________________________________
Agent/Attorney Address: _________________________________________________________
City, State, Zip: _________________________________________________________________
Agent/Attorney Phone #: _________________ Agent/Attorney e-mail: ____________________
Sussex County, DE – Application for Group Residential Facility for Persons with Disabilities
Page | 2
Las
t updated 8/5/2016
Crit
eria for Demonstrating Property Use as a Group Residential Facility for
Persons with Disabilities.
(Please provide a written statement regarding each criteria)
Disability means, with respect to a person: (1) A physical or mental impairment which substantially limits
one or more of such person's major life activities, (2) a record of having such impairment, or (3) being
regarded as having such an impairment, but such term does not include current, illegal use of a controlled
substance as defined in § 102 of the Controlled Substances Act (21 U.S.C. 802) or Title 16 of Chapter 47,
Uniform Controlled Substances Act. 6 Del. C. § 4602(10).
1. Housing
A. How long is it anticipated that the occupants of the facility will stay at the facility?
B. Are the occupants anticipated to treat the facility as their home, even
on a temporary
basis and, if so, how?
2. Physical or Mental Impairment
Examples include, but are not limited to: recovery from drug or alcohol addiction,
chronic depression, mental retardation, organic brain syndrome, emotional or mental
illness, learning disabilities, physiological disorder or condition, cosmetic disfigurement,
anatomical loss affecting various body systems.
A. Does the Applicant intend to provide housing for persons with a physical or mental
impairment?
(1) Describe the type(s) of impairment(s) that occupants are anticipated to possess.
(2) Provide documentation as an attachment to this Application demonstrating the
Applicant’s intent to provide this type of housing.
Sussex County, DE – Application for Group Residential Facility for Persons with Disabilities
3. Substantial Limitation of a Major Life Activity
"Major life activities” include, but are not limited to, caring for oneself, performing
manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working.
A. Is it anticipated that the physical or mental impairment substantially limits one or
more of such person’s major life activities and, if so, how?
B. What is the major life activity that is anticipated to be substantially limited?
4. Number of Persons
A. Is the facility anticipated to serve 10 or fewer persons with physical or mental
impairments on a 24-hour basis?
5. State Licensing
A. Is the facility required to be licensed or approved by a State agency? ____________
B. If so required, when does the Applicant anticipate applying for such
licensure/approval? If licensure/approval has already been granted, please provide
the details and any supporting documentation.
P a ge | 3
Last updated 8/5/2016
Sussex County, DE – Application for Group Residential Facility for Persons with Disabilities
Page | 4
Last updated 8/5/2016
* Please be advised that the decision of the Department is final when signed by the Director of the
Planning and Zoning Department and will be mailed to the Applicant within three (3) business days.
Any final decision of the Department may be appealed to the Sussex County Board of Adjustment
within thirty (30) days after the final decision of the Department. To determine whether the decision
has been made prior to receiving the decision in the mail, you may call the Planning & Zoning
Department at (302) 855-7878. Please include the case number when calling about the decision.
* Please be advised that any action taken in reliance on the Department’s decision before it is finalized
and the expiration of any applicable appeal period is taken at the Applicant’s risk.
The undersigned states that that he or she has completed this Application honestly, truthfully and to
the best of his/her knowledge and belief.
________________________________________ ______________________
Applicant Signature Date
For office use only:
Date Submitted: ___________________
Staff accepting application: _______________ Application & Case #: __________________
Location of property:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Decision of the Department of Planning and Zoning:
The Application: Meets __________________
Does not meet ____________
the definition of a single family dwelling under the Sussex County Code Chapter 115 (Zoning), §
115-4(B) as a group residential facility licensed and approved by the appropriate state agencies
serving 10 or fewer persons with disabilities on a twenty-four-hour-per-day basis.
__________________________________
Director, Sussex County Planning & Zoning
Date: ______________________
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Sussex County, Delaware Ap plication for Group Residential (Sussex County Council)

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Completed 18 July 2020

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