Downloadable forms from the ADLM County Environmental Public Health Department.


  Environmental Health Forms: Appanoose, Davis, Lucas & Monroe
                                                                      Counties (ADLM)

These forms are from the county Environmental Health office and are for general public use. These files have been created for your use and are in a PDF format. If you don't have a program that can read PDF files, please click HERE to get the Adobe Reader. Other information may go here also as deemed needed by the Office Holder.

 

FOOD

Adobe PDF icon Complaint Form
Adobe PDF icon Basic Requirements for a Food Establishment
Adobe PDF icon Application for Temporary Food Service
Adobe PDF icon Temporary Food Service Pre-Opening Self-Inspection Checklist
Adobe PDF icon Application to Sell Potentially Hazardous Foods at a Farmer's Market
Adobe PDF icon Temporary Food Establishments and Farmer's Market Potentially Hazardous Food Licensees (.pdf document)
Adobe PDF icon Temporary Food Stand Hand Washing Setup (.pdf document)
Adobe PDF icon Application for Mobile Food Unit / Pushcart License
Adobe PDF icon Application for Retail Food Establishment License (Grocery)
Adobe PDF icon Application for Food Service Establishment License (Restaurant)
Adobe PDF icon Application for Home Food Establishment
   
  HOTEL / MOTEL
Adobe PDF icon Hotel / Motel Application
Adobe PDF icon Hotel / Motel Application Pg.2
   
  SEPTIC
Adobe PDF icon Application and Permit Decentralized Disposal System
Adobe PDF icon OSWAP Approval Form
   
  WELLS
Adobe PDF icon Application for Private Water Construction Permit
Adobe PDF icon Abandoned Water Well Plugging Record
Adobe PDF icon Requirements for Properly Plugging Abandoned Wells (.pdf document)
Adobe PDF icon ISUE: Safe Farm: Abandoned Wells Pose a Safety Hazard (.pdf document)
Adobe PDF icon ISUE: Coping With Contaminated Wells (.pdf document)
Adobe PDF icon Groundwater Hazard Statement Form / Groundwater Hazard Statement Instructions
   
  OTHER
Adobe PDF icon Vending Machine Application
Adobe PDF icon Vending Machine Application Pg.2

 
             

Playground at Grant Elementary School

Cannon - Lovilia, Iowa

Melrose Methodist Cemetery

Monroe County Courthouse - lawn