REPUBLIC OF THE PHILIPPINES

MUNICIPALITY OF BASISTA
PROVINCE OF PANGASINAN

MUNICIPAL HEALTH OFFICE

Sanitary Permit No.______________

SANITARY PERMIT TO OPERATE

A _________________________________________________________________
Issued to ___________________________________________________________
Address ____________________________________________________________
Date Issued __________, 20 ____ Date of Expiration ________________________
This permit is not transferable and will be revoked for violation of any sanitary
ordinance, rules, of regulation.

NORA A. CAGUNOT LILIBETH A. FERMIN, M.D., MPH

Municipality sanitary inspector Municipal Health Officer
O.R. No. ________________
Dated __________________
Issued at ________________
INSTRUCTIONS:
-Issue this form the RSI and MHO to any person to entity who wishes to operate and
establish (Food and Agro-Industrial If the establishment meets the requirements and
after payment of the sanitary permit fee.
- After issuance record is in the Registry Book of sanitary Permits.
- Have it posted in a conspicuous place within the establishment for public
information.
- Recommended for renewal every year one week before the expiration date.