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Douglas County Shoreland Mitigation / Preservation Agreement Rev 10/2018 SHORELAND MITIGATION/PRESERVATION AFFIDAVIT USE ONLY BLACK INK ON THIS FORM DO NOT WRITE IN THIS SPACE Agreement Date (Must be same as the notarization date) Governmental Unit DOUGLAS COUNTY Riparian Owner(s) (please print) Permit Number We, Riparian owner(s) acknowledge that application is being made for the installation or construction of a structure in the shoreland setback area on the following property: (Provide legal description in this space) Name and return address: Douglas County Zoning Department Tax Parcel Number: (required) As an inducement to the County of Douglas to issue a zoning permit in accordance with Section IX Douglas County Shoreland Ordinance for the above described property, owner(s) agree to do the following: 1 . Owner(s) agrees to conform to all applicable requirements of the General Code of Ordinances for Douglas County, 8.4 Shoreland Zoning Ordinance Sec. VI & IX, relating to shoreland vegetative buffer zone establishment, restoration enhancement and/or preservation. The definition of a vegetative buffer zone is: An area along, and parallel to, the ordinary high water mark, approximately one half the distance from the ordinary high water mark to the building setback line, that is either undisturbed or restored with native vegetation that provides or will provide natural features and functions for fish and wildlife habitat, water quality protection and scenic beauty. 2. The owner(s) agrees to allow authorized representatives of Douglas County to enter upon the owner’s property at the above description to inspect the structure(s) authorzed by permit and to determine if the shoreland vegetative buffer meets the definition of a qualified buffer or if it has been fully restored and maintained as indicted by the owner’s plan. 3. If applicable, owner(s) agrees that Douglas County may revoke the permit and order removal of the structure(s) authorized conditionally by said permit if, upon inspection, the shoreland vegetative buffer, as approved in the owner’s plan, has been removed, destroyed, degraded and/or reduced in size below the minimal requirement. Said buffer shall remain and be preserved upon this described property in perpetuity. 4. If applicable, owner(s) agrees that removal of the structures authorized by the 59.692 WI Stats permit and/or Douglas County Shoreland Ordinance IX permit will not void this agreement or authorize the removal, destruction, degradation and/or reduction in size of the shoreland vegetative buffer. 5. This agreement shall be binding upon the owner(s), their heirs, successors and assigns. The owner(s) shall submit the agreement to the Douglas County Zoning Office and the agreement shall be recorded by the Register of Deeds in a manner which will notify any individual referencing the deed to the property as to the existence of this agreement. Property Owner(s) Name(s) - Please Print ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss. County ) Personally came before me on the above-named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. Notary Public, State of Wisconsin My Commission □ Is Permanent / □ Expires Notarized Property Owner's Signature(s) Governmental Unit Official Signature Zoning Coordinator Personal information you provide may be used for secondary purposes [Privacy Law s. 15.04(1)(m)]