Form Dhcs 5115 Draft - Zoning Approval printable pdf download

Form Dhcs 5115 Draft - Zoning Approval

State of California—Health and Human Services Agency

Department of Health Care Services

TOBY DOUGLAS

EDMUND G. BROWN JR.

DIRECTOR

GOVERNOR

TO:

LOCAL PLANNING DEPARTMENT

FROM:

DEPARTMENT OF HEALTH CARE SERVICES

SUBSTANCE USE DISORDER COMPLIANCE DIVISION

LICENSING AND CERTIFICATION BRANCH DIVISION

SUBJECT:

ZONING APPROVAL

The Department of health Care Services certifies residential and outpatient alcohol and/or other

drug treatment programs. These programs are required by certification standards to obtain a local

building use permit, zoning approval, or a letter indicating that zoning approval is not required by

the local authorities.

Attached is a sample form which indicates the information required by the Department in order to

process applications for program certification. Please feel free to copy this form onto your

letterhead when requests are received by your office for zoning approval, or you may use the form

as typed and affix an official seal.

Thank you for your cooperation and assistance to these programs which provide a valuable service

to our communities. If you have any questions, please contact Field Services at (916) 322-2911.

Attachment

Substance Use Disorder Compliance Division

Licensing and Certification Branch, MS 2600

PO Box 997413

Sacramento, CA 95899-7413

Phone: (916) 322-2911

Fax (916) 322-2658

DHCS 5115 (rev 07/14)

Form Dhcs 5115 Draft - Zoning Approval