With the deal (duplex), I am acquiring a tenant on the bottom floor.

My actual cashflow is barely $100 and it would be negative if I were to factor in all additional costs(i.e.

In addition, locate the other wholesalers in town so you're getting deals from as many sources as possible.

You could offer to repair the property for an additional cost, this has worked several times for me.

In addition the bank could take forever to get an acceptance and the interest rates might have changed by then affecting the price you can pay etc.It helps waiting sometimes if market value is rising and you have a set price but if the market is going flat and interest rates rise or market prices go down it can be a negative.No legal advice. 

The county said 2-4 units were no problem but 6 would require additional approvals.

What are some ways I could acquire this property?

If you don't want to borrow anything additional, you would be doing a rate and term refinance.  

In addition there are elderly people in need of assistance by way of assisted living.Is it possible to approach a land developer (apartment or assisted living/health care) about entering into a 100 lease agreement whereby I make the land available under a lease but they develop the property, manage it, and maintain the operation?  

You also may want to look at a site called houseflippingworksheet.com for additional help on how estimate costs of rehab.